Academic Commons Search Resultshttp://academiccommons.columbia.edu/catalog.rss?f%5Bsubject_facet%5D%5B%5D=Mental+health&q=&rows=500&sort=record_creation_date+desc
Academic Commons Search Resultsen-usThe Hurricane Sandy Person Report: Disaster Exposure, Health Impacts, Economic Burden, and Social Well-Beinghttp://academiccommons.columbia.edu/catalog/ac:187433
Abramson, David M.; Van Alst, Donna; Merdjanoff, Alexis; Piltch-Loeb, Rachael; Beedasy, Jaishree; Findley, Patricia; Peek, Lori Ann; Mordy, Meghan; Moroso, Sandra; Ocasio, Kerrie; Park, Yoon Soo; Sury, Jonathan; Tobin-Gurley, Jenniferhttp://dx.doi.org/10.7916/D8ST7P3QTue, 28 Jul 2015 00:00:00 +0000The impact a disaster has on the health of a population can be described as having a “dose-response” relationship: the larger the “dose” of the disaster, the greater the health impact or “response” among those individuals and communities exposed. This PERSON Briefing Report describes the impact of Hurricane Sandy (the dose) on the health and well-being of adults and children exposed to the storm (the response). Data for the report are drawn from the baseline survey of the Sandy Child and Family Health (S-CAFH) Study, an observational cohort study of nearly 1,000 randomly-selected New Jersey residents who were living in areas of the state exposed to the storm in 2012. Participants in the study represent over 1 million people living in Sandy’s “Disaster Footprint,” the hurricane-exposed portions of the state. This report describes and examines several critical aspects of individual health and well-being that may be associated with the storm, including: 1. Physical health of adults; 2. Psychological and emotional health of adults; 3. Social and economic health of adults; 4. Health and well-being of children; and 5. The association between disaster exposure and individual outcomes.Public health, Public policy, Social research, Mental healthdma3, jb3506, lap2190, ysp2102, jjs2154National Center for Disaster Preparedness, Sociomedical SciencesReportsFrequent binge drinking five to six years after exposure to 9/11: Findings from the World Trade Center Health Registryhttp://academiccommons.columbia.edu/catalog/ac:186638
Welch, Alice E.; Caramanica, Kimberly; Maslow, Carey B.; Cone, James E.; Farfel, Mark R.; Keyes, Katherine M.; Stellman, Steven D.; Hasin, Deborah S.http://dx.doi.org/10.7916/D87D2T8MSat, 13 Jun 2015 21:46:35 +0000Background: Exposure to 9/11 may have considerable long-term impact on health behaviors, including increased alcohol consumption. We examined the association between frequent binge drinking, posttraumatic stress disorder (PTSD), and number of 9/11-specific experiences among World Trade Center Health Registry (Registry) enrollees five-to-six years after 9/11. Methods: Participants included 41,284 lower Manhattan residents, workers, passers-by, and rescue/recovery workers aged 18 or older without a pre-9/11 PTSD diagnosis who completed Wave 1 (2003–2004) and Wave 2 (2006–2007) interviews. Frequent binge drinking was defined as consuming five or more drinks on five or more occasions in the prior 30 days at Wave 2. Probable PTSD was defined as scoring 44 or greater on the PTSD Checklist. 9/11 exposure was measured as the sum of 12 experiences and grouped as none/low (0–1), medium (2–3), high (4–5) and very high (6+).Results: Frequent binge drinking was significantly associated with increasing 9/11 exposure and PTSD. Those with very high and high exposures had a higher prevalence of frequent binge drinking (13.7% and 9.8%, respectively) than those with medium and low exposures (7.5% and 4.4%, respectively). Upon stratification, very high and high exposures were associated with frequent binge drinking in both the PTSD and no PTSD subgroups. Conclusions: Our findings suggest that 9/11 exposure had an impact on frequent binge drinking five-to-six years later among Registry enrollees. Understanding the effects of traumatic exposure on alcohol use is important to identify risk factors for post-disaster alcohol misuse, inform policy, and improve post-disaster psychological and alcohol screening and counseling.Epidemiology, Health sciences, Mental healthkmk2104, sds91, dsh2EpidemiologyArticlesAdolescent behavior and PTSD 6–7 years after the World Trade Center terrorist attacks of September 11, 2001http://academiccommons.columbia.edu/catalog/ac:186635
Mann, Mana; Li, Jiehui; Farfel, Mark R.; Maslow, Carey B.; Osahan, Sukhminder; Stellman, Steven D.http://dx.doi.org/10.7916/D8GT5M91Sat, 13 Jun 2015 21:32:08 +0000Behavioral problems and psychopathologies were reported in children exposed to the World Trade Center (WTC) attacks in New York City within 2–3 y post-disaster. Little is known of subsequent 9/11 related behavioral and emotional problems. We assessed risk factors for behavioral difficulties and probable posttraumatic stress disorder (PTSD) in 489 adolescent enrollees ages 11–18 y of age in the World Trade Center Health Registry cohort using the Strengths and Difficulties Questionnaire (SDQ) and DISC Predictive Scales (DPS), respectively, as reported by the adolescents. Associations between parental PTSD and adolescent PTSD and behavioral problems were studied in a subset of 166 adolescent-parent pairs in which the parent was also a Registry enrollee. Nearly one-fifth (17.4%) of the adolescents, all of whom were 5–12 y old at the time of the attacks, scored in the abnormal (5.7%) or borderline (11.7%) range of total SDQ. Problems were more frequent in minority, low-income, and single-parent adolescents. Abnormal and borderline SDQ scores were significantly associated with direct WTC exposures and with WTC-related injury or death of a family member. Adolescent PTSD was significantly associated with WTC exposure and with fear of one's own injury or death, and with PTSD in the parent (OR = 5.6; 95% CI 1.1–28.4). This adolescent population should be monitored for persistence or worsening of these problems. Co-occurrence of parent and child mental health symptoms following a disaster may have implications for healthcare practitioners and for disaster response planners.Epidemiology, Mental healthsds91EpidemiologyArticlesChronic Probable PTSD in Police Responders in the World Trade Center Health Registry Ten to Eleven Years After 9/11http://academiccommons.columbia.edu/catalog/ac:186629
Cone, James E.; Li, Jiehui; Kornblith, Erica; Gocheva, Vihra; Stellman, Steven D.; Shaikh, Annum; Schwarzer, Ralf; Bowler, Rosemarie M.http://dx.doi.org/10.7916/D80V8BXXFri, 12 Jun 2015 16:29:57 +0000Background: Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. Methods: Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. Results: Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011–2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. Conclusion: Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed.Epidemiology, Mental healthsds91EpidemiologyArticlesPosttraumatic Stress Disorder after Hurricane Sandy among Persons Exposed to the 9/11 Disaster.http://academiccommons.columbia.edu/catalog/ac:186626
Caramanica, Kimberly; Brackbill, Robert M.; Stellman, Steven D.; Farfel, Mark R.http://dx.doi.org/10.7916/D889151HFri, 12 Jun 2015 15:46:50 +0000BACKGROUND: Traumatic exposure during a hurricane is associated with adverse mental health conditions post-event. The World Trade Center Health Registry provided a sampling pool for a rapid survey of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012. This study evaluated the relationship between Sandy experiences and Sandy-related posttraumatic stress disorder (PTSD) among individuals previously exposed to the September 11, 2001 (9/11) disaster.
METHODS: A total of 4,558 surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. Sandy exposures included witnessing terrible events, Sandy-related injury, fearing for own life or safety of others, evacuation, living in a home that was flooded or damaged, property loss, and financial loss. Sandy-related PTSD was defined as a score of ≥44 on a Sandy-specific PTSD Checklist. RESULTS: PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events. CONCLUSIONS: Sandy-related stress symptoms indicative of PTSD affected a significant proportion of persons who lived in flooded areas of the NYC metropolitan area. Prior 9/11-related PTSD increased the likelihood of Sandy-related PTSD, while social support was protective. Public health preparation for events similar to Sandy should incorporate outreach and linkages to care for persons with prior disaster-related trauma.Epidemiology, Mental healthsds91EpidemiologyArticlesComorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster.http://academiccommons.columbia.edu/catalog/ac:186623
Caramanica, Kimberly; Brackbill, Robert M.; Liao, Tim; Stellman, Steven D.http://dx.doi.org/10.7916/D8HT2NFDFri, 12 Jun 2015 15:26:47 +0000Many studies report elevated prevalence of posttraumatic stress disorder (PTSD) and depression among persons exposed to the September 11, 2001 (9/11) disaster compared to those unexposed; few have evaluated long-term PTSD with comorbid depression. We examined prevalence and risk factors for probable PTSD, probable depression, and both conditions 10-11 years post-9/11 among 29,486 World Trade Center Health Registry enrollees who completed surveys at Wave 1 (2003-2004), Wave 2 (2006-2007), and Wave 3 (2011-2012). Enrollees reporting physician diagnosed pre-9/11 PTSD or depression were excluded. PTSD was defined as scoring ≥ 44 on the PTSD Checklist and depression as scoring ≥ 10 on the 8-item Patient Health Questionnaire. We examined 4 groups: comorbid PTSD and depression, PTSD only, depression only, and neither. Among enrollees, 15.2% reported symptoms indicative of PTSD at Wave 3, 14.9% of depression, and 10.1% of both. Comorbid PTSD and depression was associated with high 9/11 exposures, low social integration, health-related unemployment, and experiencing ≥ 1 traumatic life event post-9/11. Comorbid persons experienced poorer outcomes on all PTSD-related impairment measures, life satisfaction, overall health, and unmet mental health care need compared to those with only a single condition. These findings highlight the importance of ongoing screening and treatment for both conditions, particularly among those at risk for mental health comorbidity.Epidemiology, Mental healthsds91EpidemiologyArticlesMeasuring Psychopathology: Exploring Construct Validity Evidence for PTSD A 2010 Haitian Earthquake Examplehttp://academiccommons.columbia.edu/catalog/ac:187016
Hermosilla, Sabrinahttp://dx.doi.org/10.7916/D8HX1BRCThu, 07 May 2015 00:25:23 +0000Measurement is the foundation of epidemiologic thought and practice. The appropriate measurement of exposures and outcomes of interest is the underlying assumption to all causal investigations. Poor quality measurement, be it through inappropriate data collection methods or changing diagnostic criteria, which can result in erroneous estimates, has a deleterious impact on scientists, policy makers, and the public.
Mental health disorders particularly suffer from a lack of diagnostic clarity as diagnosis is often based on self-report of overlapping symptoms with no clear measureable biomarkers. The release of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) in May of 2013 is the most recent attempt to codify existing diagnostic criteria for psychiatric disorders. Posttraumatic stress disorder (PTSD) diagnostic criteria shifted from a three-cluster approach of avoidance, hyper-arousal, and re- experiencing to a four-cluster approach of avoidance, arousal, negative cognitions and mood, and re- experiencing. The very existence of multiple diagnostic frameworks for the same psychiatric disorder is proof that accurate diagnosis is a complex and unresolved issue that warrants investigation.
This complexity in posttraumatic stress disorder (PTSD) symptom presentation, limits our ability to develop appropriate responses. In this dissertation I conducted four independent but related studies to explore the construct validity of PTSD. In Chapter 1 I systematically reviewed the extant empiric literature from PubMed and PsychINFO on PTSD symptom structure to identify a universal PTSD factor structure. I found 40 (3%) of 1,302 citations published between 1980-2014 provided empiric PTSD factor structure estimates forming the basis of my review. While consensus exists with respect to the general multifactorial make-up of PTSD, a universal understanding of the specific operationalization of this structure, supported by the empiric literature, is absent.
In Chapter 2, I used population-based, cross-sectional data from adult survivors of the 2010 earthquake in Haiti, to assesses model fit of six theoretical factor structures of PTSD: one-factor Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV; three-factor DSM-IV-TR (arousal, avoidance, and intrusion); three-main factor (arousal, avoidance, and intrusion) and one-hierarchical factor DSM-IV-TR; four-factor King 1998 (avoidance, hypervigilance, emotional numbing, re-experiencing); four-factor Simms 2002 (avoidance, dysphoria, hyperarousal, intrusion); and four-factor DSM-5 (arousal, avoidance, intrusion, negative mood and cognition) models through confirmatory factor analyses (CFA). While all models adequately fit the data, the three-factor DSM-IV-TR (arousal, avoidance, and intrusion) model best fit the sample (χ2=593.257, 116 degrees of freedom; RMSEA=0.056; CFI=0.927; TLI=0.915, WRMR=1.769; AIC=24,760.459; and BIC=24,952.178).
Again drawing on the cross-sectional, population data from Haitian earthquake survivors, in Chapter 3 I used multiple linear regressions to model pre-, peri-, and post-earthquake factor associations with mean PTSD symptom cluster (arousal, intrusion, and avoidance, validated in Chapter 2) endorsement. I found that mean PTSD symptom factor endorsement is heterogeneously associated with pre-, peri-, and post- earthquake factors, consistent with dimensional theoretical foundations: arousal endorsement more likely to be associated with pre-earthquake factors, intrusion endorsement more likely to be associated with factors across the temporal field, and avoidance endorsement more likely to be associated with post- earthquake factors.
In Chapter 4, I used exploratory factor analysis (EFA) to assess the factor stability of the DSM-IV-TR (arousal, intrusion, avoidance) defined PTSD structure when major depressive disorder (MDD) items are introduced, in the same Haitian post-earthquake population-based study. A six-factor, 25-item model was estimated and fit the data (χ2=253.427, 165 degrees of freedom, p<0.001; RMSEA=0.021, 90% CI:0.016, 0.026; CFI=0.987; TLI=0.976) better than the PTSD-only model specified in Chapter 2. PTSD-specific items did not load on the original PTSD factors or with the original factor items (new factors included items from 0-3 different original PTSD factors), in the presence of MDD items. PTSD dimensionality was not stable in the presence of MDD items, thus challenging the discriminant validity of PTSD.
This exploration into PTSD construct validity found that while consensus exists with respect to the general multifactorial make-up of PTSD, a universal understanding of the specific operationalization of this structure, supported by the empiric literature, is absent. The tight range in model fit statistics documented in the CFA provides additional evidence of this, suggesting that empirical-based model selection is insufficient to universally characterize PTSD. Given the overall consensus of general factors, the significant and heterogeneous pre-, peri-, and post-earthquake factor associations with the unique PTSD symptom clusters provides additional evidence of the multidimensional theoretical mechanisms behind PTSD psychopathology. PTSD model stability, an indication of discriminant validity, failed to hold when challenged by MDD items, further challenging PTSD construct validity.
There are several important implications of this work. First, based on the systematic review and CFA findings, adjudication of PTSD model selection based on empiric findings is insufficient and should be theoretically driven. Future investigations should always include the most commonly supported models as they develop and refine additional models, thus enabling rigorous cross-context, cross-potentially traumatic event, and cross-study comparisons that are currently not possible. Second, the multidimensional modeling of PTSD factors provided valuable insight into the psychopathology of PTSD without additional data collection burden and should be widely adopted. Researchers should look to model PTSD both as a dichotomous variable and on a continuous scale, both as a complete construct and by each dimensional component. Third, while the exploration into discriminant validity builds on another study that found PTSD factor structure unstable in the presence of MDD item challenges, more research is needed here to understand the theoretic and empiric utility of the specified six-factor model across settings and diagnostic criteria. Fourth, while endeavoring to explore construct validity, exploratory qualitative methods with populations beyond the highly studied U.S. military populations are needed to propose additional items that could, provide valuable missing empiric evidence for PTSD factor dimensionality.Epidemiology, Public health, Mental healthEpidemiologyDissertationsFamily Care: An Exploratory Studyhttp://academiccommons.columbia.edu/catalog/ac:185903
Zweben, Allenhttp://dx.doi.org/10.7916/D81R6PGRTue, 28 Apr 2015 00:00:00 +0000Eighty-five sponsors in a Veterans Administration family care program were interviewed for the purpose of ascertaining whether or not the social environment provided a viable alternative to institutional living for the chronic mentally ill. Also, the impact of various descriptive factors of the setting on the social characteristics in the home was estimated. A level of restrictiveness scale (areas in which the freedom of the residents is restricted) and a level of deviation from normative living scale (areas in which residents are excluded from family activities) were utilized to measure the social characteristics of the family care environment. A high degree of each of these factors has been linked with a custodial care type of arrangement and a low degree of these dimensions has been associated' with a rehabilitative type of dwelling. Fifteen per cent of the homes scored above 80% on the level of restrictiveness and only 5% of the residences fell into the same category on the level of deviation from normative living (maximum score 100%), indicating that only a small minority of homes could be placed in a custodial care type category in relation to each of these dimensions. Moreover, a sizeable proportion of homes, approximately 40% of the sample, scored under 50% on the level of deviation from normative living demonstrating that some opportunities are provided for residents to experience different facets of family living. The lack of association found between the level of restrictiveness and degree of deviation from normative living would seem to indicate that the pattern of care is less consistently structured than other dwellings dealing with a similar population. This inconsistency may be the result of a variety of "cross-pressures" on the sponsors related to the decentralized manner in which the program is administered. Sponsors who were previously employed in a custodial care setting scored significantly lower on the level of deviation from normative living scale than sponsors lacking such experience. Sixty-nine per cent of the "trained" sponsors as compared with 39% of the "untrained" sponsors scored below the median on the level of deviation from normative living (p < .01), indicating that the former group may be more involved in "rehabilitative" tasks than the latter group. Younger sponsors appeared to maintain more restrictive homes than older caretakers. Sixty-seven per cent of the caretakers under 40 years of age scored above the median on the level of restrictiveness whereas only 29% of caretakers over 60 years of age scored above the median on the same dimension (p < .12), indicating that there may be more restrictions in homes managed by younger sponsors than in those managed by older ones. Comments obtained from the sponsors seem to suggest that the motivation of the individual for participating in the family care program may play an important role in shaping the structure of the setting. Such individuals as the older person who joins the program for companionship and the former employee of a custodial care facility who desires to take on a broader, more active role with psychiatric patients, may tend to establish settings consistent with these needs. What is noteworthy is the lack of relationship between size of the home and the social dimensions in the environment. This negative finding brings into question a modification in family care programs which has been considered by some or already implemented by others, namely, limiting the number of ex-patients in a home. Based upon the findings different hypotheses were formulated to be tested in future research.Mental health, Social workaz173Social WorkDissertationsPsychosocial Stressors and Major Depression, Schizophrenia, and Schizophreniform Disorderhttp://academiccommons.columbia.edu/catalog/ac:185906
Williams, Janet B.W.http://dx.doi.org/10.7916/D8S75F8FTue, 28 Apr 2015 00:00:00 +0000This study explored the relationship between the severity and types of psychosocial stressors and three major mental disorders. The data were derived from the field trials of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), in which over 12,000 patients from all over the country were evaluated by over 500 clinicians. Two hundred forty-seven patients with Major Depression and 247 with Schizophrenia were randomly selected for this study, along with all 112 patients given the diagnosis of Schizophreniform Disorder, a disorder similar to Schizophrenia except for its brief duration. The number of psychosocial stressors recorded by the evaluating clinician for each subject was examined, and each stressor was classified according to whether it represented an entrance into or exit from the social field of the subject, whether or not it was desirable, whether or not its occurrence had been under the control of the subject, the number of Life Change Units it entailed, and what area of the subject's life is affected. These variables were then compared across diagnostic groups, for individuals with and without associated Personality Disorders. In addition, for each diagnostic group, the relationship between the subjects' highest mean level of adaptive functioning and the mean severity of their psychosocial stressors was examined, using the multiaxial system of DSM-III. Major findings that replicated those reported in the literature include that a greater proportion of individuals with Major Depression were reported to have experienced a greater number of stressors, undesirable events, entrances, and uncontrollable events, than individuals with Schizophrenia. Significant new findings include that, for Schizophrenia, the highest level of adaptive functioning in the past year and level of severity of stressors experienced prior to episode onset are positively correlated, while for Major Depression these variables are negatively correlated. The results for Schizophreniform Disorder are equivocal, with similar results to Major Depression for some stressor dimensions, and midway between the other groups on others. The implications for social work practice of these findings and further study of life events are great, for primary, secondary, and tertiary prevention of mental illness.Mental health, Psychology, Social workjbw5Clinical Psychology, Social WorkDissertationsAn investigation into problem benzodiazepine use among individuals with a prescriptionhttp://academiccommons.columbia.edu/catalog/ac:185277
Fenton, Miriam Chttp://dx.doi.org/10.7916/D8ZK5FKGFri, 27 Mar 2015 00:00:00 +0000In recent years, problem use of classified prescription drugs in the United States has become a critical public health concern garnering increased attention and resources. Although the focus has primarily been on problem use of prescription drugs with the highest abuse potential, evidence of the increasing prevalence and growing burden of problem benzodiazepine use in the United States is mounting. Most epidemiological research on problem prescription drug use, including benzodiazepines, has focused on use among individuals without a prescription. However, problem use also includes use with a prescription, but in ways, or for reasons, not recommended by a doctor. Of particular importance are individuals with a benzodiazepine prescription who experience clinically significant impairment or distress as a result of using their prescription in problematic ways. Several prescription-related risk factors could increase the risk of problem benzodiazepine use among individuals prescribed benzodiazepines. These include characteristics of the benzodiazepines prescribed (including dosage and abuse liability of the prescribed benzodiazepine), the amount of benzodiazepine prescribed over time (including medication possession ratio [i.e. whether the benzodiazepine recipient has more medication than is medically necessary] and days supply of medication) and prescription contextual variables (including whether the prescription recipient also receives other controlled substances and utilizes psychotherapeutic services). In addition, characteristics of the benzodiazepine prescription recipient (including alcohol disorders, drug disorders, anxiety disorders and mood disorders) could also predict problem benzodiazepine use. This dissertation aims to consider the independent and joint roles of these factors in the risk of problem benzodiazepine use among individuals with a prescription. To this end, the current dissertation consists of three parts: a systematic literature review and two analytic research papers investigating risk factors for the development of problem benzodiazepine use, using prospective individual-level medical and pharmacy claims information in the 2003-2004 Thompson Reuters MarketScanÂ® Commercial Claims Databases. Modifiable variables including prescription characteristics, the amount of benzodiazepine prescribed over time and prescription contextual factors independently increased the risk of problem benzodiazepine use among individuals with a prescription. Psychiatric disorders, for which benzodiazepines are indicated (alcohol and anxiety disorders), or used off-label (drug and mood disorders), independently increased the risk of problem benzodiazepine use among individuals with a prescription. Further, psychotherapy and opioid prescriptions modified the increased risk of problem benzodiazepine use conferred by an anxiety disorder. This information can be used to develop specifically targeted prevention and treatment interventions, such as surveillance systems, to address the burden of problem benzodiazepine use in the U.S.Epidemiology, Mental healthmcf2140EpidemiologyDissertationsChild mental health in Jordanian orphanages: effect of placement change on behavior and caregivinghttp://academiccommons.columbia.edu/catalog/ac:183552
MacKenzie, Michael J.; Gearing, Robin E.; Schwalbe, Craig S.; Ibrahim, Rawan W.; Brewer, Kathryne B.; Al-Sharaihah, Rashahttp://dx.doi.org/10.7916/D8MG7NBFThu, 26 Feb 2015 00:00:00 +0000Background: To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. Methods: An assessment was completed of 134 children between 1.5? 12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. Results: 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. Conclusions: These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.Mental healthmm3038, rg2372, css2109, kbb2110Social WorkArticlesThe mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, Northern Iraq: A brief qualitative studyhttp://academiccommons.columbia.edu/catalog/ac:181686
Bolton, Paul; Michalopoulos, Lynn T. M.; Ahmed, Ahmed Mohammed Amin; Murray, Laura K.; Bass, Judithhttp://dx.doi.org/10.7916/D8C24V6PMon, 26 Jan 2015 00:00:00 +0000Background: From 1986-9, the Kurdish population of Iraqi Kurdistan was subjected to an intense campaign of military action, and genocide by the central Iraq government. This campaign, referred to as the Anfal, included systematic attacks consisting of aerial bombings, mass deportation, imprisonment, torture, and chemical warfare. It has been estimated that around 200,000 Kurdish people disappeared. Purpose: To gain a better understanding of current priority mental health and psychosocial problems among Kurdish survivors of the Anfal, and to inform the subsequent design of culturally appropriate and relevant assessment instruments and services to address these problems. The study examined 1) the nature and cause of current problems of survivors of torture and/or civilian attacks and their families, 2) what survivors do to address these problems, and 3) what they felt should be done. Methods: We used a grounded theory approach. Free list interviews with a convenience sample (n=42) explored the current problems of Kurdish persons affected by torture. Subsequent key informant interviews (n=21) gathered more detailed information on the priority mental health problem areas identified in the free list interviews. Results: Major mental health problem areas emerging from the free list interviews (and explored in the key informant interviews) included 1) problems directly related to the torture, 2) problems related to the current situation, and 3) problems related to the perception and treatment by others in the community. Problems were similar, but not identical, to Western concepts of depression, anxiety, PTSD and related trauma, and traumatic grief. Conclusion: Iraqi Kurdish torture survivors in Iraq have many mental health and psychosocial problems found among torture survivors elsewhere. The findings suggest that the problems are a result of the trauma experienced as well as current stressors. Development of mental health assessment tools and interventions should therefore address both previous trauma and current stressors.Mental health, Epidemiologylm2996Social WorkArticlesExamining a Sociocultural Model: Racial Identity, Internalization of the Dominant White Beauty Standards, and Body Images among Asian American Womenhttp://academiccommons.columbia.edu/catalog/ac:178853
Cheng, Pei-Hanhttp://dx.doi.org/10.7916/D8DV1HHPMon, 13 Oct 2014 00:00:00 +0000A plethora of research has shown that body image dissatisfaction significantly impacts women's psychological well-being. However, most of the research studies have only focused on weight or body shape concerns. Little attention was paid to concerns related to other body parts. Additionally, the lack of research on Asian American women has resulted in limited knowledge about the manifestation of their body image concerns, which led to limited culturally-responsive treatments attending to their needs. This current study aimed to bridge the gap in current literature by examining the relationship between racial identity, internalization of the dominant White beauty standards, body image, and psychological distress among Asian American women. The potential ethnic differences in internalization of the dominant White beauty standards were explored. The last research question explored Asian American women's satisfaction with discrete body parts. There was a total of 472 Asian American adult female participants for this current study. All of the participants completed a questionnaire package, which included a personal demographic sheet, the People of Color Racial Identity Attitude Scale (Helm, 1995), the Sociocultural Attitudes Towards Appearance Questionnaire-3 (Thompson, van den Berg, Roehing, Guarda, & Heinberg, 2004), and the Multidimensional Body Self Relations Questionnaire-Appearance Scales (Brown, Cash, & Mikulka, 1990). Path analysis showed several significant results. First, the Awareness-Dominant racial profile was found to significantly associate with higher levels of Body Area Satisfaction. Second, Internalization-General was found to have a significant positive effect on Appearance Orientation and reverse effect on Self-Classified Weight. Third, findings showed that Pressures had a significant positive effect on Overweight Preoccupation and Self-Classified Weight, and negative effect on Appearance Orientation and Body Area Satisfaction. Results showed no ethnic group differences in the internalization of the dominant White beauty standards among Asian American women. Lastly, results showed that Asian American women in this study reported more satisfaction with their racially defined features than body parts that were related to weight, fat distribution, and fitness. The findings make significant contributions by showing the importance of racial identity and internalization of the dominant White beauty standards in Asian American women's body image development and psychological well-being. Limitations, implications for clinical practices, and directions for future studies are discussed.Counseling psychology, Mental health, Asian American studiesphc2109Counseling and Clinical Psychology, Counseling PsychologyDissertationsLongitudinal population-based studies of affective disorders: Where to from here?http://academiccommons.columbia.edu/catalog/ac:185219
Beard, John; Galea, Sandro; Vlahov, Davidhttp://dx.doi.org/10.7916/D81V5CCBMon, 08 Sep 2014 00:00:00 +0000Longitudinal, population-based, research is important if we are to better characterize the lifetime patterns and determinants of affective disorders. While studies of this type are becoming increasingly prevalent, there has been little discussion about the limitations of the methods commonly used. Discussion paper including a brief review of key prospective population-based studies as the basis for a critical appraisal of current approaches. We identified a number of common methodological weaknesses that restrict the potential of longitudinal research to characterize the diversity, prognosis, and determinants of affective disorders over time. Most studies using comprehensive diagnostic instruments have either been of relatively brief duration, or have suffered from long periods between waves. Most etiologic research has focused on first onset diagnoses, although these may be relatively uncommon after early adulthood and the burden of mental disorders falls more heavily on individuals with recurring disorders. Analysis has tended to be based on changes in diagnostic status rather than anges in symptom levels, limiting study power. Diagnoses have generally been treated as homogeneous entities and few studies have explored whether diagnostic subtypes such as atypical depression vary in their etiology or prognosis. Little research has considered whether there are distinct trajectories of symptoms over time and most has focused on individual disorders such as depression, rather than considering the relationship over time between symptoms of different affective disorders. There has also been limited longitudinal research on factors in the physical or social environment that may influence the onset, recurrence or chronicity of symptoms. Many important, and in some respects quite basic, questions remain about the trajectory of depression and anxiety disorders over the life course and the factors that influence their incidence, recurrence and prognosis. Innovative approaches that consider symptoms of all affective disorders, and how these change over time, has the potential to greatly increase our understanding of the heterogeneity of these important conditions and of the individual and environmental characteristics that influence their life course. Using longitudinal research to define sub classes of affective disorders may also be of great benefit for studies seeking to define the genetic determinants of susceptibility to these conditions.Mental healthsg822EpidemiologyArticlesPerformance measurement for co-occurring mental health and substance use disordershttp://academiccommons.columbia.edu/catalog/ac:184651
Dausey, David; Pincus, Harold A.; Herrell, Jameshttp://dx.doi.org/10.7916/D8X065G1Mon, 08 Sep 2014 00:00:00 +0000Co-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both. We convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality. We chose twelve measures that demonstrated promise for future pilot testing and refinement. The criteria that we applied to select these measures included: balance across structure, process, and outcome measures, quantitative ratings from the panelists, narrative comments from the panelists, and evidence the measure had been tested in a similar form elsewhere. To be successful performance measures need to be developed in such a way that they align with needs of administrators and providers. Policymakers need to work with all stakeholders to establish a concrete agenda for developing, piloting and implementing performance measures that include COD. Future research could begin to consider strategies that increase our ability to use administrative coding in mental health and substance use disorder systems to efficiently capture quality relevant clinical data.Mental healthhap2104PsychiatryArticlesConstruct development: The Suicide Trigger Scale (STS-2), a measure of a hypothesized suicide trigger statehttp://academiccommons.columbia.edu/catalog/ac:183579
Yaseen, Zimri; Katz, Curren; Johnson, Matthew S.; Eisenberg, Daniel; Cohen, Lisa; Galynker, Igorhttp://dx.doi.org/10.7916/D8H130DJMon, 08 Sep 2014 00:00:00 +0000This study aims to develop the construct of a 'suicide trigger state' by exploring data gathered with a novel psychometric self-report instrument, the STS-2. The STS-2, was administered to 141 adult psychiatric patients with suicidal ideation. Multiple statistical methods were used to explore construct validity and structure. Cronbach's alpha (0.949) demonstrated excellent internal consistency. Factor analyses yielded two-component solutions with good agreement. The first component described near-psychotic somatization and ruminative flooding, while the second described frantic hopelessness. ROC analysis determined an optimal cut score for a history of suicide attempt, with significance of p < 0.03. Logistic regression analysis found items sensitive to history of suicide attempt described ruminative flooding, doom, hopelessness, entrapment and dread. The STS-2 appears to measure a distinct and novel clinical entity, which we speculatively term the 'suicide trigger state.' High scores on the STS-2 associate with reported history of past suicide attempt.Mental health, Psychologymsj2119Human DevelopmentArticlesNeighborhood Socioeconomic Status, Depression, and Health Status in the Look AHEAD (Action for Health in Diabetes) Studyhttp://academiccommons.columbia.edu/catalog/ac:183273
Gary-Webb, Tiffany L.; Baptiste-Roberts, Kesha; Pham, Luu; Wesche-Thobaben, Jacqueline; Patricio, Jennifer; Pi-Sunyer, F Xavier; Brown, Arleen; Jones-Corneille, LaShanda; Brancati, Frederickhttp://dx.doi.org/10.7916/D8XG9PHNMon, 08 Sep 2014 00:00:00 +0000Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression. Individual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (% living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES. Overall, the % living in poverty in the participants' neighborhoods varied, mean = 11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (β-coefficient [β] = -1.90 units, 95% CI: -3.40,-0.039), mental health (β = -2.92 units, -4.31,-1.53) and global health (β = -2.77 units, -4.21,-1.33) composite scores. In this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.Public health, Mental health, Biostatisticstlg2124EpidemiologyArticlesHopefulness predicts resilience after hereditary colorectal cancer genetic testing: a prospective outcome trajectories studyhttp://academiccommons.columbia.edu/catalog/ac:183783
Ho, Samuel; Ho, Judy; Bonanno, George A.; Chu, Annie; Chan, Emilyhttp://dx.doi.org/10.7916/D8K935XQMon, 08 Sep 2014 00:00:00 +0000Genetic testing for hereditary colorectal cancer (HCRC) had significant psychological consequences for test recipients. This prospective longitudinal study investigated the factors that predict psychological resilience in adults undergoing genetic testing for HCRC. A longitudinal study was carried out from April 2003 to August 2006 on Hong Kong Chinese HCRC family members who were recruited and offered genetic testing by the Hereditary Gastrointestinal Cancer Registry to determine psychological outcomes after genetic testing. Self-completed questionnaires were administered immediately before (pre-disclosure baseline) and 2 weeks, 4 months and 1 year after result disclosure. Using validated psychological inventories, the cognitive style of hope was measured at baseline, and the psychological distress of depression and anxiety was measured at all time points. Of the 76 participating subjects, 71 individuals (43 men and 28 women; mean age 38.9 ± 9.2 years) from nine FAP and 24 HNPCC families completed the study, including 39 mutated gene carriers. Four patterns of outcome trajectories were created using established norms for the specified outcome measures of depression and anxiety. These included chronic dysfunction (13% and 8.7%), recovery (0% and 4.3%), delayed dysfunction (13% and 15.9%) and resilience (76.8% and 66.7%). Two logistic regression analyses were conducted using hope at baseline to predict resilience, with depression and anxiety employed as outcome indicators. Because of the small number of participants, the chronic dysfunction and delayed dysfunction groups were combined into a non-resilient group for comparison with the resilient group in all subsequent analysis. Because of low frequencies, participants exhibiting a recovery trajectory (n = 3 for anxiety and n = 0 for depression) were excluded from further analysis. Both regression equations were significant. Baseline hope was a significant predictor of a resilience outcome trajectory for depression (B = -0.24, p < 0.01 for depression); and anxiety (B = -0.11, p = 0.05 for anxiety). The current findings suggest that hopefulness may predict resilience after HCRC genetic testing in Hong Kong Chinese. Interventions to increase the level of hope may be beneficial to the psychological adjustment of CRC genetic testing recipients.Mental healthgab38Counseling and Clinical PsychologyArticlesEffects of Client HIV Status and Race on Therapeutic Impressions of Counselor Traineeshttp://academiccommons.columbia.edu/catalog/ac:177148
Chen, Yu-Kanghttp://dx.doi.org/10.7916/D8B56GX1Fri, 15 Aug 2014 00:00:00 +0000Working with HIV-positive individuals may present a particular challenge to clinicians because of the phenomenon of stigma. Researchers have proposed that HIV stigma is layered with people's prejudiced attitudes toward already-stigmatized groups (e.g., sexual orientation, gender, race and ethnicity) in which people living with HIV/AIDS may have membership. Previous research has suggested that, clinicians' attitudes and reactions toward HIV and sexual orientation may significantly impact their therapeutic impressions, yet questions remain with regard to how clients' HIV status and racial identity may operate in confluence to influence clinicians' therapeutic impressions. This question may be particularly significant with regard to mental health professionals, as research also suggests that racial/ethnic minority clients can be perceived by their clinicians as more disturbed as a result of clinicians' biased racial attitudes. In the present study, case vignettes featuring hypothetical Black or White men who are either HIV-positive or HIV-negative were presented to participants to explore the influence of a client's HIV status and race upon participants' therapeutic impressions. Results indicated that participants' expectations of therapeutic process and evaluations of the clients' symptomatology were influenced by the clients' race and HIV status. Participants expected slightly greater session depth for the Black clients than the White clients in the vignettes, and their initial impressions of symptomatology were also slightly more negative toward the White clients in the vignettes. With regard to the main effect of client HIV status, participants expected slightly greater session depth for the HIV-positive clients than the HIV-negative clients in the vignettes. However, participants expected slightly less session smoothness for the HIV-positive clients in the vignettes, and they also reported lower assessment of psychological, occupational, and social functioning toward the HIV-positive clients in the vignettes. The potential interaction of the hypothetical client's race and HIV status and its effect upon participants' clinical impressions was not found significant. Implications for research and practice are discussed.Counseling psychology, Mental healthCounseling and Clinical Psychology, Counseling PsychologyDissertationsThe Association between Prenatal Maternal Mental Health and Infant Memory and Language Outcomeshttp://academiccommons.columbia.edu/catalog/ac:177094
Reese, Emily Bridget-Polidorehttp://dx.doi.org/10.7916/D87W69DJMon, 28 Jul 2014 00:00:00 +0000Prenatal maternal depression and anxiety are associated with poor infant health, behavioral and achievement outcomes. The impacts of prenatal maternal mental health on the development of particular brain-based neurocognitive systems in children are less clear. This dissertation examines the association between prenatal maternal depression and anxiety and infant memory and language outcomes. 179 infant mother dyads were recruited in South Dakota. Ninety infants were followed at 9- and 15-months, and 89 were followed at 15- and 21-months of age. These data were used to understand more clearly the association between prenatal maternal depression and anxiety and changes in infant memory and language over the first two years of life. Additionally, by measuring the interaction between prenatal mental health and parenting and the direct association of parenting on changes in infant memory and language, we can better understand if the pathway between prenatal maternal mental health and infant memory and language is biological, social or both. Results demonstrated no significant direct association between prenatal maternal depression and anxiety symptoms and changes in infant memory or language from 9 to 21 months. The HOME language and literacy subscale was associated with changes in memory and language from 9 to 21 months; the HOME parental warmth subscale was associated with changes in language from 9 to 21 months. These results were independent of prenatal maternal social risk. Implications for additional screening measures, interventions, and considerations for future research are discussed.Psychology, Neurosciences, Mental healthebp2118Human Development, Developmental PsychologyDissertationsShort-term and medium-term health effects of 9/11http://academiccommons.columbia.edu/catalog/ac:175391
Perlman, Sharon E.; Friedman, Stephen; Galea, Sandro; Nair, Hemanth P.; Erős-Sarnyai, Monika; Stellman, Steven D.; Hon, Jeffrey; Greene, Carolyn M.http://dx.doi.org/10.7916/D80Z71FKTue, 08 Jul 2014 00:00:00 +0000The New York City terrorist attacks on Sept 11, 2001 (9/11), killed nearly 2800 people and thousands more had subsequent health problems. In this Review of health effects in the short and medium terms, strong evidence is provided for associations between experiencing or witnessing events related to 9/11 and post-traumatic stress disorder and respiratory illness, with a correlation between prolonged, intense exposure and increased overall illness and disability. Rescue and recovery workers, especially those who arrived early at the World Trade Center site or worked for longer periods, were more likely to develop respiratory illness than were other exposed groups. Risk factors for post-traumatic stress disorder included proximity to the site on 9/11, living or working in lower Manhattan, rescue or recovery work at the World Trade Center site, event-related loss of spouse, and low social support. Investigators note associations between 9/11 exposures and additional disorders, such as depression and substance use; however, for some health problems association with exposures related to 9/11 is unclear.Mental health, Occupational health, Epidemiologysg822, sds91EpidemiologyArticles"Many Secrets Are Told Around Horses:" An Ethnographic Study of Equine-Assisted Psychotherapyhttp://academiccommons.columbia.edu/catalog/ac:176172
Van Tiem, Jenniferhttp://dx.doi.org/10.7916/D8PZ570PMon, 07 Jul 2014 00:00:00 +0000This dissertation presents an ethnography of equine-assisted psychotherapy (EAP) based on nine months of fieldwork at "Equine Healers," a non-profit organization in central Colorado that specialized in various therapeutic modalities associated with EAP. In bridging scholarly work around animals, a literature suffused with the notion of "companion species," as well as scholarly work around psychotherapy, and most especially the idea of "psychotherapy as conversation," the connective conflict these two interests share, and from which this dissertation emerges, is over questions of language and communication. Specifically, the overarching problem that this dissertation addresses is: what counts as talking, in the context of "the talking cure," when beings that do not share human language are necessarily implicated in human conversations. Beginning with Das' (1997) encouragement to understand "pain as the beginning of a language game," most of this dissertation will therefore be about dropping the reader into the silences between the humans and the horses, and between the words the humans use to talk about their experiences with the horses, thereby raising fundamental questions about the communicational dialectics that can transform human experiences. I argue that anthropologists must re-arrange our analytical frames around humans and animals, beginning with how we understand language, in the context of communication, to be organized. Rather than privileging subjects and objects, I suggest returning to Bateson (1972) and attempting to privilege relationships. To explore these ideas, this dissertation will attend to a particular therapeutic modality employed at Equine Healers, a set of practices called a "group sculpture." To set up and make it possible to appreciate the complexity of this modality, this dissertation will first consider framing conversations among humans and horses as rhythmically ordered interactions. To do this, I generate a model of conversation based less on grammatical rules derived from the use of words, or the possibilities offered by subject-object "thing" relationships, and instead lean on musical relationships of rhythm. Initially emerging through conversation, I then trace out rhythms carried between horses and humans by particular physical, material pieces of their world. These brushes, clickers, and bridles ultimately bridge vocal and pneumatic rhythms; and it is movement along this connection, an ebb and flow of voice and breath that, in aligning, generate opportunities for iconic relationships with one's self.Cultural anthropology, Linguistics, Mental healthjmv2138Applied Anthropology, International and Transcultural StudiesDissertationsComorbid Persistent Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5–6 Years Post-9/11 in Responders Enrolled in the World Trade Center Health Registryhttp://academiccommons.columbia.edu/catalog/ac:174649
Friedman, Stephen M.; Farfel, Mark R.; Maslow, Carey B.; Cone, James E.; Brackbill, Robert M.; Stellman, Steven D.http://dx.doi.org/10.7916/D89K48B0Wed, 04 Jun 2014 00:00:00 +0000Background Co-occurrence of lower respiratory symptoms (LRS) and posttraumatic stress disorder (PTSD) has been increasingly recognized among responders and survivors of the World Trade Center (WTC) disaster. Information is limited on the degree which comorbidity intensifies symptoms and compromises quality of life across exposed groups. Methods Among responders who completed the first and second Registry surveys, measures of respiratory illness, psychological distress, and diminished quality of life were compared between responders comorbid for LRS and PTSD and responders with only LRS or PTSD. Results Of 14,388 responders, 40% of those with LRS and 57% of those with PTSD were comorbid. When demographic and WTC exposure-related factors were controlled, comorbid responders compared to those with LRS alone were twice as likely to have frequent dyspnea and to have sought care for dyspnea. Compared to responders with PTSD alone, comorbid responders were 2.1 times more likely to report intense re-experiencing of the disaster, 2.5 times more likely to express feelings of significant non-specific psychological distress, and 1.4 times more likely to have received mental health care. Comorbid responders were approximately three times more likely to report only fair or poor general health and more than twice as likely to report being unable to perform usual activities for ≥14 of 30 days before interview. Conclusions Outcomes in comorbid responders were similar to or more severe than in comorbid survivors. Health care and disaster relief providers must suspect comorbid illness when evaluating responders' respiratory or mental illnesses and consider treatment for both.Mental health, Public health, Epidemiologysds91EpidemiologyArticlesMental Health of Those Directly Exposed to the World Trade Center Disaster: Unmet Mental Health Care Need, Mental Health Treatment Service Use, and Quality of Lifehttp://academiccommons.columbia.edu/catalog/ac:174636
Brackbill, Robert M.; Stellman, Steven D.; Perlman, Sharon E.; Walker, Deborah J.; Farfel, Mark R.http://dx.doi.org/10.7916/D8PV6HH2Wed, 04 Jun 2014 00:00:00 +0000Mental health service utilization several years following a man-made or natural disaster can be lower than expected, despite a high prevalence of mental health disorders among those exposed. This study focused on factors associated with subjective unmet mental health care need (UMHCN) and its relationship to a combination of diagnostic history and current mental health symptoms, 5–6 years after the 9-11-01 World Trade Center (WTC) disaster in New York City, USA. Two survey waves of the WTC Health Registry, after exclusions, provided a sample of 36,625 enrollees for this analysis. Important differences were found among enrollees who were categorized according to the presence or absence of a self-reported mental health diagnosis and symptoms indicative of post-traumatic stress disorder or serious psychological distress. Persons with diagnoses and symptoms had the highest levels of UMHCN, poor mental health days, and mental health service use. Those with symptoms only were a vulnerable group much less likely to use mental health services yet reporting UMHCN and poor mental health days. Implications for delivering mental health services include recognizing that many persons with undiagnosed but symptomatic mental health symptoms are not using mental health services, despite having perceived need for mental health care.Mental health, Occupational health, Public healthsds91EpidemiologyArticlesLongitudinal Mental Health Impact Among Police Responders to the 9/11 Terrorist Attackhttp://academiccommons.columbia.edu/catalog/ac:174624
Bowler, Rosemarie M.; Harris, Matthew; Li, Jiehui; Gocheva, Vihra; Stellman, Steven D.; Wilson, Katherine; Alper, Howard; Schwarzer, Ralf; Cone, James E.http://dx.doi.org/10.7916/D8TM787SWed, 04 Jun 2014 00:00:00 +0000Background Among police responders enrolled in the World Trade Center Health Registry (WTCHR), Post-traumatic Stress Disorder (PTSD) was almost twice as prevalent among women as men 2–3 years after the 9/11 attacks. Methods Police participants in the WTCHR Wave 1 survey 2–3 years after 9/11/01, were reassessed for probable PTSD at Wave 2, 5–6 years after 9/11/01, using PCL DSM-IV criteria. Results Police participants in the Wave 2 survey included 2,527 men, 413 women. The prevalence of “Probable PTSD” was 7.8% at Wave 1 and 16.5% at Wave 2. Mean PCL scores increased from 25.1 to 29.9 for men and 28.6 to 32.2 for women. Prevalence of PTSD was higher for women than for men at Wave 1 (χ2 = 10.882, P = 0.002), but not Wave 2 (χ2 = 2.416, P = 0.133). Other risk factors included losing one's job after 9/11 and being disabled. Conclusions Prevalence of probable PTSD among police doubled between 2003–2004 and 2006–2007. After the 2-year time span, the gender difference was no longer significant; prevalence of PTSD symptoms increased and there was a substantial amount of co-morbidity with other mental health problems. Further development of prevention and intervention strategies for police responders with symptoms of PTSD is needed. The observed upward trend in PCL scores over time in police officers with PCL scores less than 44, suggests that PTSD prevention and intervention strategies should be applied to all police affected by the 9/11 attacks, not limited just to those with PTSD symptoms.Mental health, Occupational health, Public healthsds91EpidemiologyArticlesCo-occurring Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5 to 6 Years After the World Trade Center Terrorist Attackhttp://academiccommons.columbia.edu/catalog/ac:174715
Nair, Hemanth P.; Ekenga, Christine C.; Cone, James E.; Brackbill, Robert M.; Farfel, Mark R.; Stellman, Steven D.http://dx.doi.org/10.7916/D8NV9GCPWed, 04 Jun 2014 00:00:00 +0000Objectives. We have described the epidemiology of co-occurring lower respiratory symptoms (LRS) and probable posttraumatic stress disorder (PTSD) 5 to 6 years after exposure to the 9/11 disaster. Methods. We analyzed residents, office workers, and passersby (n = 16 363) in the World Trade Center Health Registry. Using multivariable logistic regression, we examined patterns of reported respiratory symptoms, treatment sought for symptoms, diagnosed respiratory conditions, mental health comorbidities, quality of life, and unmet health care needs in relation to comorbidity. Results. Among individuals with either LRS or PTSD, 24.6% had both conditions. The odds of comorbidity was significantly higher among those with more severe 9/11 exposures. Independent of 9/11 exposures, participants with LRS had 4 times the odds of those without it of meeting criteria for PTSD, and those with PTSD had 4 times the odds of those without it of meeting criteria for LRS. Participants with comorbidity had worse quality of life and more unmet mental health care needs than did all other outcome groups. Conclusions. Respiratory and mental illness are closely linked in individuals exposed to 9/11 and should be considered jointly in public health outreach and treatment programsPublic health, Mental health, Environmental healthsds91EpidemiologyArticlesChronic Physical Health Consequences of Being Injured During the Terrorist Attacks on World Trade Center on September 11, 2001http://academiccommons.columbia.edu/catalog/ac:173775
Brackbill, Robert M.; Cone, James E.; Farfel, Mark R.; Stellman, Steven D.http://dx.doi.org/10.7916/D8W9578KFri, 09 May 2014 00:00:00 +0000Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003−2004 and 2006−2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5–6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002–2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.Public health, Mental health, Epidemiologysds91EpidemiologyArticlesSchool Interventions After the Joplin Tornadohttp://academiccommons.columbia.edu/catalog/ac:173648
Kanter, Robert K.; Abramson, David M.http://dx.doi.org/10.7916/D8VH5KX0Wed, 07 May 2014 00:00:00 +0000Background/Objective To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado. METHODS: Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians. Report After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs. CONCLUSIONS: Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.Public health, Mental healthrkk2117, dma3National Center for Disaster Preparedness, Sociomedical SciencesArticles"My Life as it is has Value:" A Narrative Approach to Understanding Life Course Experiences of Older Adults with Schizophreniahttp://academiccommons.columbia.edu/catalog/ac:175312
Ogden, Lydia P.http://dx.doi.org/10.7916/D8B27SCXWed, 16 Apr 2014 00:00:00 +0000This study used thematic narrative analysis to address the question: How do older adults who experience serious ongoing symptoms of schizophrenia understand and express stories of their personal survivorship in the face of life-course and present-time adversities? Framed by the developmental life course perspective and using major constructs of the theory of cumulative adversity and advantage to formulate a line of semi-structured questioning for narrative interviews about the life course experiences of older adults with schizophrenia who experienced ongoing illness symptoms, analysis of 31 interviews with six older adults with schizophrenia yielded findings across five central areas. Shared core themes included: 1) "My life as it is has value:" Narrating schizophrenia in later life; 2) "I have a key and live like a real person:" Homelessness and housing challenges in retrospect; 3) "There's not been jobs:" The meaning of employment; 4) "God told me how we're going to meet back up:" Narratives of relational conflict and loss, adjustment and renewal. A fifth area of findings developed the theory of cumulative adversity and advantage across the life course with schizophrenia. These results improve our understanding of the subjective experience of a highly vulnerable but grossly understudied and underserved population. Recommendations for focusing future research and development of more effective social work practice and policies are made.Social work, Mental health, Gerontologylpo2001Social WorkDissertationsClinical Significance of Psychotic Experiences in the General Populationhttp://academiccommons.columbia.edu/catalog/ac:172847
DeVylder, Jordan Edgarhttp://dx.doi.org/10.7916/D8G15XZBFri, 11 Apr 2014 00:00:00 +0000Epidemiological studies have demonstrated that the prevalence of psychotic disorders is exceeded by that of sub-threshold psychotic experiences, which are phenomenologically similar to threshold psychosis but of less intensity or associated impairment. Recent research has highlighted the potential clinical significance of psychotic experiences with regards to psychological distress, service utilization, psychiatric comorbidities, and suicide risk. The aims of this three paper dissertation are to: 1) determine risk for suicidal behavior among respondents with psychotic experiences; 2) examine the prevalence of psychotic experiences among respondents with common mental disorders, and describe the clinical significance of these symptoms when occurring in the context of common mental disorders; and 3) evaluate factors associated with the persistence or remission of psychotic experiences in the general population. For all three papers, data were drawn from the Collaborative Psychiatric Epidemiology Surveys (n=20,013), composed of the National Comorbidity Survey-Replication, National Latino and Asian American Study, and National Survey of American Life. Psychotic experiences and other clinical variables were assessed using the World Health Organization Composite International Diagnostic Interview, version 3.0. Analyses consisted primarily of logistic regression models, with effect sizes calculated as adjusted odds ratios. Psychotic experiences were found to be associated with elevated risk for suicidal ideation and suicide attempts, and with multiple co-morbidities with common mental health conditions. The persistence of psychotic experiences over time was primarily associated with the type of symptom experienced (i.e. hearing voices) and with marital status. Co-morbid mental health conditions, although extensive, did not predict the persistence of psychotic experiences, although persistent psychotic experiences were associated with ongoing suicide risk. Together, these data support the clinical significance of sub-threshold psychotic experiences among a large general population sample of adults in the United States. The most clinically notable features of psychotic experiences are that they indicate drastically elevated risk for suicide attempts (particularly severe attempts with intent to die) and the presence of multiple co-morbid mental health conditions. These findings will have clinical utility in highlighting unique needs of individuals with sub-threshold psychotic symptoms, and will have public health value in identifying a significant risk factor for severe suicidal behavior that may be easily screened in the general population as well as in clinical settings.Social work, Epidemiology, Mental healthjed2147Social WorkDissertationsEpigenetic modifications associated with suicide and common mood and anxiety disorders: a systematic review of the literaturehttp://academiccommons.columbia.edu/catalog/ac:169843
El-Sayed, Abdulrahman M.; Haloossim, Michelle Rachel; Galea, Sandro; Koenen, Karestan C.http://dx.doi.org/10.7916/D8X92885Wed, 05 Feb 2014 00:00:00 +0000Epigenetic modifications are those reversible, mitotically heritable alterations in genomic expression that occur independent of changes in gene sequence. Epigenetic studies have the potential to improve our understanding of the etiology of mood and anxiety disorders and suicide by bridging the gap in knowledge between the exogenous environmental exposures and pathophysiology that produce common mood and anxiety disorders and suicide. We systematically reviewed the English-language peer-reviewed literature about epigenetic regulation in these disorders between 2001–2011, summarizing and synthesizing this literature with respect to directions for future work. Twenty-one articles met our inclusion criteria. Twelve studies were concerned with epigenetic changes among suicide completers; other studies considered epigenetic regulation in depression, post-traumatic stress disorder, and panic disorder. Several studies focused on epigenetic regulation of amine, glucocorticoid, and serotonin metabolism in the production of common mood and anxiety disorders and suicide. The literature is nascent and has yet to reach consensus about the roles of particular epigenetic modifications in the etiology of these outcomes. Future studies require larger sample sizes and measurements of environmental exposures antecedent to epigenetic modification. Further work is also needed to clarify the link between epigenetic modifications in the brain and peripheral tissues and to establish ‘gold standard’ epigenetic assays.Genetics, Mental health, Psychologyame2145, mrh2151, sg822, kck5Epidemiology, Sociomedical SciencesArticlesExamining Bullying, Harassment, and Horizontal Violence (BHHV) in Student Nurseshttp://academiccommons.columbia.edu/catalog/ac:166572
Geller, Nicolehttp://hdl.handle.net/10022/AC:P:22001Thu, 17 Oct 2013 00:00:00 +0000Bullying, harassment, and horizontal violence (BHHV) is commonly reported by student nurses during their clinical education. Despite decades of mention in the literature, no instrument is available to specifically measure the student nurse's experience of BHHV during clinical education. Purpose: The purpose of this dissertation is to examine the experience of BHHV in a population of student nurses matriculating during their clinical education in New York. The experience of BHHV is measured with the BEHAVE Survey, the instrument developed and tested for this purpose. Methods: This dissertation is presented in three manuscripts: (1) a comprehensive review of the literature using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement as the methodological guide, (2) the initial psychometric testing of BEHAVE (Bulling, harassment, and HorizontAl ViolencE) for validity and reliability at a university-based school of nursing in New York, and (3) a descriptive, quantitative survey of baccalaureate nursing students at a university-based school of nursing in New York completed as a field test of the BEHAVE. Results: Despite variations in methodology, measurement, terms, definitions, and coding of behaviors and sources of BHHV, the findings of this literature review indicate that student nurses are common targets of BHHV during clinical education, regardless of demographic characteristics, disability, sexual orientation, geography location, academic institution or program type. Psychometric testing indicated: scale-level content validity index among experts 0.89, r = 0.97, a Cronbach's á 0.94, and percent agreement 93% in test-retest reliability. BEHAVE was administered to a total of 32 participants (96.7% participation rate). Approximately 72% reporting current experienced or observed BHHV with 46.8% (36/77) of incidents originated from a nurse. Conclusions: The evidence from both the literature and this field trial suggests that BHHV is a common experience among nursing students. This is significant because student nurses are vulnerable to BHHV and studies including students have been limited to date. Therefore, it behooves the research community to continue to explore the impact of BHHV on the student nurse's socialization into the professional nursing role. Further knowledge may inform targeted interventions to reduce BHHV and improve the ability of nursing students to minimize the impact of BHHV should it occur.Nursing, Mental healthnfg2103NursingDissertationsWhy the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugshttp://academiccommons.columbia.edu/catalog/ac:163122
Buckingham, Elizabeth; Schrage, Ezra Blake; Cournos, Francinehttp://hdl.handle.net/10022/AC:P:21027Thu, 11 Jul 2013 00:00:00 +0000People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.Clinical psychology, Mental healthebs2168, fc15Clinical Psychology, General StudiesArticlesLife Cycle and Suicidal Behavior among Womenhttp://academiccommons.columbia.edu/catalog/ac:162910
Mendez-Bustos, Pablo; Lopez-Castroman, Jorge; Baca-Garcia, Enrique; Ceverino, Antoniohttp://hdl.handle.net/10022/AC:P:20953Mon, 08 Jul 2013 00:00:00 +0000It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide.Behavioral sciences, Psychology, Mental healtheb2452PsychiatryArticlesThe Comorbidity of Eating Disorders and Substance Abuse in Adolescents and Young Adultshttp://academiccommons.columbia.edu/catalog/ac:162403
Trilling, Eleanorhttp://hdl.handle.net/10022/AC:P:20766Mon, 17 Jun 2013 00:00:00 +0000Eating disorders and substance abuse are both predominant issues that the United States faces today especially within the adolescent populations. Together, they can have serious consequences. And unfortunately many individuals suffering from an eating disorder or substance abuse problem develop its counterpart at some point in their lifetime. The National Center on Addiction and Substance Abuse (CASA) at Columbia University found in their three year study (2003) that “individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those to abuse alcohol or illicit drugs and those who abuse alcohol or illicit drugs are up to 11 times likelier to have eating disorders”. This paper explores the comorbidity of eating disorders and substance abuse among the adolescent population in America. It will first look very briefly at each disorder separately, and then review the literature and studies that look at the overlap between the two. By comparing common personal, social and societal risks that are shared by those affected by eating disorders and substance abuse, this paper will attempt to explain the co-occurrence between the two disorders and demonstrate the causal linkages. Finally, I will bring my own thoughts, reactions, critiques and areas where I see need for further exploration.Mental health, Clinical psychologyet2318Psychology (Barnard College)ReportsElectromagnetic Field Modeling of Transcranial Electric and Magnetic Stimulation: Targeting, Individualization, and Safety of Convulsive and Subconvulsive Applicationshttp://academiccommons.columbia.edu/catalog/ac:174843
Deng, Zhi-Dehttp://hdl.handle.net/10022/AC:P:20557Tue, 04 Jun 2013 00:00:00 +0000The proliferation of noninvasive transcranial electric and magnetic brain stimulation techniques and applications in recent years has led to important insights into brain function and pathophysiology of brain-based disorders. Transcranial electric and magnetic stimulation encompasses a wide spectrum of methods that have developed into therapeutic interventions for a variety of neurological and psychiatric disorders. Although these methods are at different stages of development, the physical principle underlying these techniques is the similar. Namely, an electromagnetic field is induced in the brain either via current injection through scalp electrodes or via electromagnetic induction. The induced electric field modulates the neuronal transmembrane potentials and, thereby, neuronal excitability or activity. Therefore, knowledge of the induced electric field distribution is key in the design and interpretation of basic research and clinical studies. This work aims to delineate the fundamental physical limitations, tradeoffs, and technological feasibility constraints associated with transcranial electric and magnetic stimulation, in order to inform the development of technologies that deliver safer, and more spatially, temporally, and patient specific stimulation. Part I of this dissertation expounds on the issue of spatial targeting of the electric field. Contrasting electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) configurations that differ markedly in efficacy, side effects, and seizure induction efficiency could advance our understanding of the principles linking treatment parameters and therapeutic outcome and could provide a means of testing hypotheses of the mechanisms of therapeutic action. Using the finite element method, we systematically compare the electric field characteristics of existing forms of ECT and MST. We introduce a method of incorporating a modality-specific neural activation threshold in the electric field models that can inform dosage requirements in convulsive therapies. Our results indicate that the MST electric field is more focal and more confined to the superficial cortex compared to ECT. Further, the conventional ECT current amplitude is much higher than necessary for seizure induction. One of the factors important to clinical outcome is seizure expression. However, it is unknown how the induced electric field is related to seizure onset and propagation. In this work, we explore the effect of the electric field distribution on the quantitative ictal electroencephalography and current source density in ECT and MST. We further demonstrate how the ECT electrode shape, size, spacing, and current can be manipulated to yield more precise control of the induced electric field. If desirable, ECT can be made as focal as MST while using simpler stimulation equipment. Next, we demonstrate how the electric field induced by transcranial magnetic stimulation (TMS) can be controlled. We present the most comprehensive comparison of TMS coil electric field penetration and focality to date. The electric field distributions of more than 50 TMS coils were simulated. We show that TMS coils differ markedly in their electric field characteristics, but they all are subject to a consistent depth--focality tradeoff. Specifically, the ability to directly stimulate deeper brain structures is obtained at the expense of inducing wider electric field spread. Figure-8 type coils are fundamentally more focal compared to circular type coils. Understanding the depth--focality tradeoff can help researchers and clinicians to appropriately select coils and interpret TMS studies. This work also enables the development of novel TMS coils with electronically switchable active and sham modes as well as for deep TMS. Design considerations of these coils are extensively discussed. Part II of the dissertation aims to quantify the effect of individual, sex, and age differences in head geometry and conductivity on the induced neural stimulation strength and focality of ECT and MST. Across and within ECT studies, there is marked unexplained variability in seizure threshold and clinical outcomes. It is not known to what extent the age and sex effects on seizure threshold are mediated by interindividual variation in neural excitability and/or anatomy of the head. Addressing this question, we examine the effect on ECT and MST induced field characteristics of the variability in head diameter, scalp and skull thicknesses and conductivities, as well as brain volume, in a range of values that are representative of the patient population. Variations in the local tissue properties such as scalp and skull thickness and conductivity affect the existing ECT configurations more than MST. On the other hand, the existing MST coil configurations show greater sensitivity to head diameter variation compared to ECT. Due to the high focality of MST compared to ECT, the stimulated brain volume in MST is more sensitive to variation in tissue layer thicknesses. We further demonstrate how individualization of the stimulus pulse current amplitude, which is not presently done in ECT or MST, can be used as a means of compensating for interindividual anatomical variability, which could lead to better and more consistent clinical outcomes. Part III of the dissertation aims to systemically investigate, both computationally and experimentally, the safety of TMS and ECT in patients with a deep-brain stimulation system, and propose safety guidelines for the dual-device therapy. We showed that the induction of significant voltages in the subcutaneous leads in the scalp during TMS could result in unintended and potentially dangerous levels of electrical currents in the DBS electrode contacts. When applying ECT in patients with intracranial implants, we showed that there is an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. Safety concerns presently limit the access of patients with intracranial electronic devices to therapies involving transcranial stimulation technology, which may preclude them from obtaining appropriate medical treatments. Gaining better understanding of the interactions between transcranial and implanted stimulation devices will demarcate significant safety risks from benign interactions, and will provide recommendations for reducing risk, thus enhancing the patient's therapeutic options.Electrical engineering, Electromagnetics, Mental healthElectrical EngineeringDissertationsRace-ethnic discrimination, Major Depression, and Alcohol Use Disorder among US-born and immigrant minoritieshttp://academiccommons.columbia.edu/catalog/ac:174813
Kapadia, Amyhttp://hdl.handle.net/10022/AC:P:20425Thu, 23 May 2013 00:00:00 +0000This dissertation used data from The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to expand upon what is known about the relationship between perceived race-ethnic discrimination and mental health outcomes while uniquely comparing race-ethnic groups across both US-born and immigrant populations. Specifically, two DMS-IV disorders, Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) were examined as outcomes. The dissertation sample (n = 13,914) was drawn from Wave II of the data and included Black, Hispanic, and Asian respondents. The first question addresses the associations between perceived race-ethnic discrimination and the mental health disorders. Question two examined the risk and protective roles of four cultural-social factors for both disorders as well as their moderating roles in the race-ethnic discrimination-mental health relationship. Prevalence analysis revealed that almost 20% of minorities experienced past-year race-ethnic discrimination. Results from logistic regressions found that minorities who experienced race-ethnic discrimination were about two times as likely to have MDD or AUD than minorities who did not experience race-ethnic discrimination (ORs = 2.0 and 1.8, respectively). Comparisons across sub-populations of US-born, immigrant, Black, Hispanic, Asian, and gender groups found a few differences in terms of the effects of discrimination and mental health disorders. While moderation analyses failed to yield significant results for race-ethnic discrimination, the four cultural and social factors appeared to moderate the relationship between MDD and AUD, respectively. Findings corroborate and expand upon previous work demonstrating a consistent, strong, and positive relationship between perceived race-ethnic discrimination and mental health outcomes across minority populations yielding practice and policy implications. Further research is needed to examine causal associations using longitudinal data as well as to elucidate upon the role of protective and risk factors given cultural and community-based factors.Mental healthask2123Social WorkDissertationsPediatric Terrorism Preparedness National Guidelines and Recommendations: Findings of an Evidenced-based Consensus Processhttp://academiccommons.columbia.edu/catalog/ac:161085
Markenson, David; Redlener, Irwin E.http://hdl.handle.net/10022/AC:P:20296Mon, 13 May 2013 00:00:00 +0000A cadre of experts and stakeholders from government agencies, professional organizations, emergency medicine and response, pediatrics, mental health, and disaster preparedness were gathered to review and summarize the existing data on the needs of children in the planning, preparation, and response to disasters or terrorism. This review was followed by development of evidence-based consensus guidelines and recommendations on the needs of children in disasters, including chemical, biological, and radiological terrorism. An evidence-based consensus process was used in conjunction with a modified Delphi approach for selection of topic areas and discussion points. These recommendations and guidelines represent the first national evidence-based standards for pediatric disaster and terrorism preparedness.Public health, Medicine, Mental healthir2110Population and Family Health, Pediatrics, National Center for Disaster PreparednessArticlesRemembrance and Wellness Five Years After 9/11http://academiccommons.columbia.edu/catalog/ac:160955
Gaffney, Donna A.; Thomas, Gregory A.; Carter, Abigail; Hoffer-Adou, Marcela; Norris, Stefanie; Mladenik, Sue; Goodrich, Donaldhttp://hdl.handle.net/10022/AC:P:20258Tue, 07 May 2013 00:00:00 +0000It has been five years. For some people time has barely passed. Tuesday, September 11, 2001 feels like yesterday. To others these last five years seem an eternity. Many people have slipped back into their everyday lives. The horrific images, unimaginable sadness, security threats and unanswered questions have given way to a world that on the surface feels predictable and safe. But there are abrupt reminders that the world is not safe or predictable; everything familiar to us can change in an instant.Counseling psychology, Mental healthNational Center for Disaster PreparednessPromotional materialsEvaluation of a Fotonovela to Increase Depression Knowledge and Reduce Stigma Among Hispanic Adultshttp://academiccommons.columbia.edu/catalog/ac:160582
Unger, Jennifer B. ; Cabassa, Leopoldo J. ; Molina, Gregory B. ; Contreras, Sandra ; Baron, Melvin http://hdl.handle.net/10022/AC:P:20161Thu, 02 May 2013 00:00:00 +0000Fotonovelas—small booklets that portray a dramatic story using photographs and captions— represent a powerful health education tool for low-literacy and ethnic minority audiences. This study evaluated the effectiveness of a depression fotonovela in increasing depression knowledge, decreasing stigma, increasing self-efficacy to recognize depression, and increasing intentions to seek treatment, relative to a text pamphlet. Hispanic adults attending a community adult school (N = 157, 47.5 % female, mean age = 35.8 years, 84 % immigrants, 63 % with less than high school education) were randomly assigned to read the fotonovela or a low-literacy text pamphlet about depression. They completed surveys before reading the material, immediately after reading the material, and 1 month later. The fotonovela and text pamphlet both produced significant improvements in depression knowledge and self-efficacy to identify depression, but the fotonovela produced significantly larger reductions in antidepressant stigma and mental health care stigma. The fotonovela also was more likely to be passed on to family or friends after the study, potentially increasing its reach throughout the community. Results indicate that fotonovelas can be useful for improving health literacy among underserved populations, which could reduce health disparities.Mental healthljc2139Social WorkArticlesThe Role of Smoking in Cocaine Addictionhttp://academiccommons.columbia.edu/catalog/ac:158568
Colnaghi, Luca http://hdl.handle.net/10022/AC:P:19542Fri, 29 Mar 2013 00:00:00 +0000The 2010 National Survey on Drug Use and Health reported that almost 37 million Americans,1 2 years of age or older, have tried cocaine in their lifetime, and 5.7 million have used it in the past year – making cocaine the second most commonly used drug of abuse in the United States. The reasons for its popularity are its immediate psychological effects. Snorted or injected cocaine induces self-confidence, euphoria and good feelings, magnifying the intensity of almost all normal pleasures. However, cocaine use also causes medical complications like respiratory failure, cardiovascular and gastrointestinal problems and paranoia. Moreover, after prolonged exposure, individuals become addicted to it, losing control over use of the drug and engaging in destructive behavior related to cocaine procurement. Cocaine addiction is a chronic relapsing condition with high risk of medical complications, cognitive impairment, financial ruin and social issues.Neurosciences, Mental health, PsychobiologyItalian AcademyPresentationsPsychosis Risk and Prevention of Persistent and Severe Mental Illness: Implications for Social Work Practicehttp://academiccommons.columbia.edu/catalog/ac:156601
DeVylder, Jordan Edgarhttp://hdl.handle.net/10022/AC:P:19026Wed, 13 Feb 2013 00:00:00 +0000The prognosis of schizophrenia and other psychotic disorders may be improved through efforts to identify at-risk individuals and to provide early interventions prior to the first episode of psychosis. Psychosis-risk syndrome is gaining recognition as a distinct clinical condition, and may be included as a diagnosis in the upcoming version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). As direct mental health practitioners, social workers are in an ideal position to both address the diverse psychosocial needs and improve the accessibility of services for this difficult-to-define population. As macro-level practitioners, social workers can provide a valuable perspective on ethical issues while advocating to reduce the stigma surrounding the provision of intensive mental health services to individuals struggling with psychosis-risk syndrome.Social work, Mental healthjed2147Social WorkArticlesMental Health Courts: An Interface Between Social Work and Criminal Justicehttp://academiccommons.columbia.edu/catalog/ac:156757
Roberts, Leslie http://hdl.handle.net/10022/AC:P:19021Wed, 13 Feb 2013 00:00:00 +0000Mental health courts (MHCs) are emerging as a critical element in the nationwide effort to counter overcrowding in the US prison system and more adequately address the plight of offenders who are diagnosed with a mental illness. The goals of MHCs, an example of problem-solving courts, are to improve the quality of life for those involved in the criminal justice system, link clients to community treatment resources, and reduce recidivism and crime rates in a more cost-effective manner than within the traditional criminal justice process. This article provides a brief history of MHCs, including the rationale behind their initial implementation, an overview of their clientele and process, a review of the role social workers play, arguments for and against their broader introduction, and specific research recommendations to better ascertain their current and future effectiveness. Although MHCs are still too nascent to draw broad conclusions about their rates of efficacy, early results are promising.Social work, Mental health, Criminologyler2115Social WorkArticlesRescuing the Self from Selflessness: How we can be better at helping others by helping ourselveshttp://academiccommons.columbia.edu/catalog/ac:156461
Salee, Steve ; Sibley, Jonathan http://hdl.handle.net/10022/AC:P:18994Fri, 08 Feb 2013 00:00:00 +0000This article examines the risks faced by helping professionals, such as clinical social workers, due to their tendency to be more attentive to clients than to their own needs. It is suggested that clinicians can improve job engagement and minimize burnout risk through increased self-awareness and self-care. Using an approach based on Giddens’ (1984) structuration theory, the authors provide specific suggestions for self-awareness and self-care, including the concept that workers should improve and exercise their self-advocacy skills as a form of self-care.Social work, Mental healthSocial WorkArticlesThe Sibling Relationship in Foster Care: Policy Implicationshttp://academiccommons.columbia.edu/catalog/ac:156482
Sheehan, Kate http://hdl.handle.net/10022/AC:P:19005Fri, 08 Feb 2013 00:00:00 +0000The majority of children placed into foster care are separated from their siblings upon entering the child welfare system. Some research suggests that siblings enjoy more stable home environments and fewer behavioral problems when placed together in care. The sibling relationship may provide stability, consistency, and unconditional positive regard to the children most at risk for poor outcomes such as anxiety, depression, low self-esteem, and loss of identity. This paper argues that foster care and child welfare agencies must institute the changes necessary to make sibling relationships a priority. Recommendations for integrating the protection of sibling relationships in the placement process are proposed.Social work, Individual and family studies, Mental healthkms2123Social WorkArticlesAnger and Military Veteranshttp://academiccommons.columbia.edu/catalog/ac:156491
Miller, Scott http://hdl.handle.net/10022/AC:P:19010Fri, 08 Feb 2013 00:00:00 +0000Anger problems are most evident in veterans who are diagnosed with Posttraumatic Stress Disorder (PTSD) and have been exposed to combat. Because of the institutionalized role anger plays in military training, identity, and culture, anger problems are also an issue for former soldiers who have neither PTSD nor combat experience. Consequently, anger problems are an issue for many veterans whose inability to manage and express their anger constructively inhibits psychosocial functioning in multiple areas, including personal relationships, employment, self-esteem, and behavioral self-control. Empirically supported group interventions addressing this issue adhere to the principles of evidence-based practice and are particularly important given the current geopolitical climate. This paper reviews some of the current literature on clinical interventions for veterans experiencing anger problems and acknowledges the increasingly important role social workers are playing as mental health service providers to veterans with anger problems at institutions such as the Department of Veterans Affairs.Social work, Mental healthswm2106Social WorkArticles“War is not the only trauma:” Rethinking Psychosocial healing in complex emergencieshttp://academiccommons.columbia.edu/catalog/ac:156473
Akesson, Bree http://hdl.handle.net/10022/AC:P:18999Fri, 08 Feb 2013 00:00:00 +0000War inevitably leads to a degree of psychological trauma among affected populations. This paper critiques Western-based, clinical interventions as detrimental to an already demoralized population. Ager’s (2002) framework of psychosocial intervention – human capacity, social ecology, and culture and values – is appropriate in the context of complex emergencies. Building upon an ecosystems perspective, Ager’s framework considers the whole individual and promotes strengths and resiliencies. Social workers are ideal facilitators of this type of community-based, culturally-salient, psychosocial programming, due to its application of the field’s core principles and its commitment to empowering community members to participate in their own recovery.Social work, Mental healthbaa15Social WorkArticlesLatino Children’s Mental Health: An Analysis of Risk Factors, Healthcare Access, and Intervention Strategieshttp://academiccommons.columbia.edu/catalog/ac:156497
Holloway, Ian http://hdl.handle.net/10022/AC:P:19014Fri, 08 Feb 2013 00:00:00 +0000Research suggests that Latino children are at an elevated risk for a variety of mental health problems (Flores, Fuentes-Afflic, Barbot, et al., 2002). Latinos are often vulnerable to the deleterious effects of poverty, institutional racism, community violence and other types of psychosocial stressors, which have been linked to negative mental health outcomes (Flisher, Kramer, Grosser, et al., 1997; Saunders, Resnick, Hoberman, et al., 1994). Furthermore, Latino children are likely to face significant barriers to accessing mental healthcare services, such as limited availability of Spanish-speaking providers, difficulty obtaining and navigating health insurance, and cultural obstacles, such as the belief that mental illness is a spiritual or religious matter. The current paper will: (1) explore specific risk factors for mental health disorders among Latino children; (2) examine barriers to appropriate mental health treatment among Latino children; (3) provide an overview of the types of intervention strategies currently used to address mental health problems among Latino children; and (4) offer recommendations for the development of additional and/or improved methods for the prevention and treatment of mental health disorders among Latino children.Social work, Mental healthiwh2101Social WorkArticlesIllness and autonomy: Neurobiology, behavior, and treatment of bipolar maniahttp://academiccommons.columbia.edu/catalog/ac:155795
Snyder, Rebekahhttp://hdl.handle.net/10022/AC:P:18810Thu, 24 Jan 2013 00:00:00 +0000Bipolar disorder (BD) is a severe and crippling mental illness, affecting 2.6 millions adults every year. Though pharmacological treatment for the disease is quite effective, we are still in our infancy in terms of our understanding of its underlying neurobiological mechanisms. Nevertheless, a variety of hypotheses have emerged that provide a strong empirical framework upon which we may construct a clearer and more definitive theory of its neural substrates. The present review focused on mechanisms of mania, as it is most commonly associated with the performance of impulsive and detrimental behaviors. Moreover, I have explored the critical question of whether BD patients experience free will and autonomy or instead are the victims of a deterministic illness, the directives of which are inevitable. It seems that, to some extent, a patient’s genetic circumstances and consequent neurobiological processes determines her behaviors. That being said, it must be assumed that each patient is, for the most part, an autonomous agent that has the ability to interfere with the forceful dictates of the disease. An agent theoretically has the choice to comply with medication, though it may be far more effortful than it would be were he not ill. However, a patient experiencing severe mania may truly be outside of the realm of autonomy, and any consequent criminal or otherwise destructive behavior should be seriously considered for exemption. Ultimately, it ought to be appreciated that no one chooses to be ill, and that it requires enormous fortitude to resist what the illness compels one to do. Those of us with healthy brains should be cognizant of this fact and sympathize accordingly.Behavioral sciences, Mental healthrms2182Psychology (Barnard College)Undergraduate thesesPsychopathology Among New York City Public School Children 6 Months After September 11http://academiccommons.columbia.edu/catalog/ac:155451
Hoven, Christina; Lucas, Christopher P.; Duarte, Cristiane S.; Cohen, Patricia R.; Goodwin, Renee D.; Wu, Ping; Mandell, Donald J.; Susser, Ezra S.; Balaban, Victor; Cohen, Michael; Woodruff, Bradley A.; Bin, Fan; Musa, George J.; Mei, Lori; Cantor, Pamela A.; Aber, J. Lawrencehttp://hdl.handle.net/10022/AC:P:15776Thu, 10 Jan 2013 00:00:00 +0000It has been proposed that the terror itself that results from a terrorist attack elicits what is perhaps one of the attack’s more profound consequences: a direct assault on the population’s mental health. Prior research suggests that in the context of a mass disaster, children may be an especially vulnerable group. Previous research has shown that direct exposure to different types of mass traumatic events is associated with an increase in posttraumatic stress symptoms among children. Postdisaster studies have also reported elevated prevalence of physical symptoms, anxiety, and depression, which are frequently comorbid with posttraumatic stress reactions among youth. Previous studies examining the results of mass trauma on child mental health have included selected or volunteer samples at the trauma site. Studies to date have not examined population-based samples; therefore, the extent to which results generalize to youth in the community, or to different levels of exposure, is not known. Moreover, previous studies have focused mainly on posttraumatic stress disorder (PTSD), and have not assessed a range of mental disorders. Several publications have documented the impact of September 11 on adults’ mental health; studies published to date have not yet directly assessed children, although some did elicit parental reports. This article reports the results of the New York City, NY, Department of Education (formerly the New York City Board of Education) study, which examined the prevalence of 8 probable mental disorders and their relationship to levels of exposure to the World Trade Center (WTC) attack in a large representative sample of New York City public school children 6 months following this disaster.Public health, Mental health, Clinical psychologych42, cd2003, prc2, rdg66, pw11, ess8Epidemiology, National Center for Disaster Preparedness, PsychiatryArticlesDisaster Care for Persons With Psychiatric Disabilities: Recommendations for Policy Changehttp://academiccommons.columbia.edu/catalog/ac:155365
Person, Cheryl; Fuller, Elizabeth J.http://hdl.handle.net/10022/AC:P:15748Fri, 04 Jan 2013 00:00:00 +0000There is growing concern that the management of persons with psychiatric disabilities after disaster has been inadequate. Unfortunately, the literature is extremely limited, and empirical evidence on the best practices for addressing the needs of persons with psychiatric disabilities after disasters is sparse. A literature search of articles published in 3 widely used databases revealed only 12 articles on the topic. The 12 reviewed articles included persons with psychiatric disabilities after both natural disasters and acts of terrorism, both in close proximity to the disaster site and far away and in 3 different treatment modalities. All of the studies used clinically based samples. The available literature indicated that many persons with psychiatric disabilities demonstrate an ability to handle the stress of a disaster without decompensation from their primary illness. However, the literature also revealed that persons with severe mental illness (SMI) can experience posttraumatic stress disorder (PTSD), depression, anxiety, and illness exacerbation after disaster. There is evidence that persons with SMI can be resilient in the short term when they are enrolled in an assertive community treatment program prior to the disaster however, the outcomes for people with severe mental illness in other treatment modalities are unclear. Well-designed studies with clinical and population-based samples on disaster reactions of persons with psychiatric disabilities are needed for disaster psychiatrists and emergency planners to develop empir· ically based treatment guidelines for this population.Public health, Public policy, Mental healthNational Center for Disaster PreparednessArticlesChallenges in Meeting Immediate Emotional Needs: Short-term Impact of a Major Disaster on Children's Mental Health: Building Resiliency in the Aftermath of Huricanne Katrinahttp://academiccommons.columbia.edu/catalog/ac:155386
Madrid, Paula; Redlener, Neil B.; Grant, Roy F.; Reilly, Michael J.http://hdl.handle.net/10022/AC:P:15756Fri, 04 Jan 2013 00:00:00 +0000Disasters, whether resulting from terrorism or natural events, have a dramatic impact on the health and well-being of children. Studies after the terror attacks of September 11, 2001, in New York City and the 1995 Oklahoma City bombing and countless reports on the impact of natural disasters on children show that a child’s mental health can suffer from direct and indirect exposure to these events. Children may react to a disaster or act of terrorism in a variety of ways. These reactions are influenced by age, developmental level, intellectual capacity, individual and family support systems, personality, and other factors. Common manifestations of psychological trauma in young children include regression, clinging behavior, inattentiveness, aggressiveness, bed-wetting, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer-lasting effects may include depression, anxiety, adjustment disorders, posttraumatic stress disorder, and interpersonal or academic difficulties. Some children are particularly vulnerable to post disaster trauma because of preexisting psychosocial stressors (homelessness, foster care, exposure to violence, etc.), low socioeconomic status, or special needs (including cognitive delays and prior mental illness). These post disaster reactions may not manifest until well after the event and could persist for years.Public health, Mental healthpam2109, rfg2101, mr2381Environmental Health Sciences, National Center for Disaster PreparednessArticlesMental health in the Wake of Hurricane Katrina: Science to Practicehttp://academiccommons.columbia.edu/catalog/ac:155389
Madrid, Paulahttp://hdl.handle.net/10022/AC:P:15757Fri, 04 Jan 2013 00:00:00 +0000This article talks about the programs that were developed post-Katrina in accordance with the mental health facilities and care programs. The Children’s Health Fund was funded 20 years ago to provide medical services to underserved children and families through mobile units. We have found mobile units to be effective ways of delivering services to people in need post-trauma or post-disaster as well as for primary care. The mental health component had not been a part of it, and I will tell you about how we began that post-9/11. As far as a public health agenda, we also felt that there was a need to make sure that the work we do is informed by research, by an understanding of what happens post-trauma, and also by a desire to understand more how can we do this in a better way next time. So research and evaluation have always been an important component of what we do. We currently have three programs in the Gulf Coast, one in Mississippi and two in Louisiana. They are comprised of a mental health unit and a medical unit. The units are big blue vans that go to places where we have identified need, and they park in sites of need, and medical and mental health professionals provide services. We use electronic records, so that is one way in which we are able to serve people who might need to move or who do not know exactly where they will be. Our goal is to serve as a “medical home.”Public health, Mental healthpam2109National Center for Disaster PreparednessReportsEstablishing Permanent Mental Health Programs Post-Hurricane Katrina: Lessons Learned and Recommendations for Practice in Underserved Communities Impacted by Mass Traumahttp://academiccommons.columbia.edu/catalog/ac:155332
Madrid, Paula; Redlener, Irwin E.; Domnitz, Rita; Grant, M.A.http://hdl.handle.net/10022/AC:P:15489Thu, 03 Jan 2013 00:00:00 +0000Operation Assist, a joint initiative of Columbia University's National Center for Disaster Preparedness and the Children's Health. Fund was formed after Hurricane Katrina hit the Gulf Coast of the United States in August 2005. Mental health, medical, and public health professionals have spent one year addressing the needs of victims through direct work and research programs, which have resulted in findings relevant to disaster preparedness, resilience, and the creation of child-focused mental health programs post-disaster. While the immediate impact of a disaster is ubiquitous and widespread, children are most likely to require mental health intervention following a disaster. It also is important to care for families and service providers who also are at risk. Operation Assist staff have worked closely with local community leaders as well as with key health and mental health officials to develop relevant programs to meet the mental health needs of children and families. The proposed presentation will describe one year's work with children and families affected by Hurricane Katrina. Program findings, recommendations for future work and implications for policy, delivery and practice that are applicable to under served communities impacted by mass trauma around the world will be discussed.Public health, Mental healthpam2109, ir2110Population and Family Health, Pediatrics, National Center for Disaster PreparednessAbstractsMeeting Mental Health Needs Following a Natural Disaster: Lessions From Hurricane Katrinahttp://academiccommons.columbia.edu/catalog/ac:155311
Madrid, Paula; Grant, Roy F.http://hdl.handle.net/10022/AC:P:15482Thu, 03 Jan 2013 00:00:00 +0000Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need.Public health, Mental healthpam2109, rfg2101National Center for Disaster PreparednessArticlesBuilding Integrated Mental Health and Medical Programs for Vulnerable Populatons Post-Disaster: Connecting Children and Families to a Medical Homehttp://academiccommons.columbia.edu/catalog/ac:155317
Madrid, Paula; Sinclaire, Heidi; Bankston, Antoinette Q.; Overholt, Sarah; Brito, Arturo; Domnitz, Rita; Grant, Roy F.http://hdl.handle.net/10022/AC:P:15484Thu, 03 Jan 2013 00:00:00 +0000Introduction: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005.Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks (“villages”) under the auspices of the [US] Federal Emergency Management Agency (FEMA). Problem: The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. Methods: The Children’s Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program (“Operation Assist”) to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children’s Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. Results: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. Conclusions: There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.Public health, Mental healthpam2109, rfg2101National Center for Disaster PreparednessArticlesMental Health Services in Louisiana School-Based Health Centers Post-Hurricanes Katrina and Ritahttp://academiccommons.columbia.edu/catalog/ac:155314
Madrid, Paula; Garfield, Richard M.; Richard, Georgina; Jaberi, Parham; Daly, Maureen; Grant, Roy F.http://hdl.handle.net/10022/AC:P:15483Thu, 03 Jan 2013 00:00:00 +0000Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed MHPs in each of the SBHCs under the auspices of the Louisiana Department of Health and Hospitals, Office of Public Health. SBHC practitioners from around the state reported that mental health service utilization rose during the 2005–2006 school year, but utilization of services increased most significantly in schools receiving the majority of displaced students. Anxiety and adjustment problems were noted as increasing the most following the hurricanes. A multitude of other conditions was also reported. By the time of this survey in April 2006, the reported prevalence of most symptoms had declined, but all remained above their pre-hurricane levels. Selfreported needs of SBHC MHPs are also discussed in light of the major natural disasters.Public health, Mental healthpam2109, rmg3, rfg2101National Center for Disaster Preparedness, NursingArticlesImpostor Syndrome Lecturehttp://academiccommons.columbia.edu/catalog/ac:154891
Drew, Joshua Adamhttp://hdl.handle.net/10022/AC:P:15335Tue, 20 Nov 2012 00:00:00 +0000A lecture on Imposter syndrome, a condition where people are unable to internalize their own success. Lecture uses real life posts and anecdotes to illustrate how the syndrome manifests and gives advice (and blogs to read) on overcoming feelings of inadequacy.Physical anthropology, Ecology, Mental healthjd2977Ecology, Evolution, and Environmental BiologyPresentationsAcculturation, Familism and Mother–Daughter Relations Among Suicidal and Non-Suicidal Adolescent Latinashttp://academiccommons.columbia.edu/catalog/ac:154483
Zayas, Luis H.; Bright, Charlotte L.; Alvarez-Sanchez, Thyria; Cabassa, Leopoldo J.http://hdl.handle.net/10022/AC:P:15250Mon, 12 Nov 2012 00:00:00 +0000We examined the role of acculturation, familism and Latina mother–daughter relations in suicide attempts by comparing 65 adolescents with recent suicide attempts and their mothers to 75 teens without any attempts and their mothers. Attempters and non-attempters were similar in acculturation and familistic attitudes but attempters report significantly less mutuality and communication with their mothers than non-attempters. Mothers of attempters reported lower mutuality and communication with their daughters than mothers of non-attempters. Small increments in mutuality decreased the probability of a suicide attempt by 57%. Acculturation and familism do not appear to play major roles in suicide attempts but relational factors may. Instituting school-based psychoeducational groups for young Latinas, particularly in middle school, and their parents, separately and jointly, and focusing on raising effective communication and mutuality between parents and adolescent daughters are important primary prevention strategies.Mental health, Hispanic American studiesljc2139Social WorkArticlesPatterns of Distress, Precipitating Events, and Reflections on Suicide Attempts by Young Latinashttp://academiccommons.columbia.edu/catalog/ac:154487
Zayas, Luis H.; Gulbas, Lauren E ; Fedoravicius, Nicole; Cabassa, Leopoldo J.http://hdl.handle.net/10022/AC:P:15251Mon, 12 Nov 2012 00:00:00 +0000By most epidemiological accounts, young US Latinas attempt suicide more often than other youth. Little is known, however, about the circumstance and internal experiences of the attempts. To understand this phenomenon, we conducted thematic analyses of twenty-seven qualitative interviews with teenage Latinas (aged 11-19) living in New York City who had attempted suicide. Collected between July 2005 and July 2009, the interviews explored the emotional, cognitive and physical experiences of the attempts and the social situations in which they took place. Results show that the girls were divisible nearly equally into a group with a stated intent of death and a group that did not intend death. The pathways to the suicidal event consisted of a pattern of continuous, escalating stress (primarily at home) that created the emotionally combustible conditions for the attempt. A trigger event that either reminded them of past stress or revived feelings of that stress catalyzed the attempt. Guilt and remorse were common responses to the suicide attempts, and on reflection the girls demonstrated some broader perspectives. Results of the analysis clarify the sociocultural context of the suicide attempts, underscoring the cultural discontinuity experienced by adolescent Latinas, who struggle to reconcile traditional Hispanic gender socialization with their own insertion in a modern Western society.Mental health, Hispanic American studiesljc2139Social WorkArticlesAzúcar y nervios: Explanatory models and treatment experiences of Hispanics with diabetes and depressionhttp://academiccommons.columbia.edu/catalog/ac:154490
Cabassa, Leopoldo J.; Hansen, Marissa C.; Palinkas, Lawrence A.; Ell, Kathleenhttp://hdl.handle.net/10022/AC:P:15253Mon, 12 Nov 2012 00:00:00 +0000This study examined the explanatory models of depression, perceived relationships between diabetes and depression, and depression treatment experiences of low-income, Spanish-speaking, Hispanics with diabetes and depression. A purposive sample (n = 19) was selected from participants enrolled in a randomized controlled trial conducted in Los Angeles, California (United States) testing the effectiveness of a health services quality improvement intervention. Four focus groups followed by 10 in-depth semi-structured qualitative interviews were conducted. Data were analyzed using the methodology of coding, consensus, co-occurrence, and comparison, an analytical strategy rooted in grounded theory. Depression was perceived as a serious condition linked to the accumulation of social stressors. Somatic and anxiety-like symptoms and the cultural idiom of nervios were central themes in low-income Hispanics' explanatory models of depression. The perceived reciprocal relationships between diabetes and depression highlighted the multiple pathways by which these two illnesses impact each other and support the integration of diabetes and depression treatments. Concerns about depression treatments included fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. This study provides important insights about the cultural and social dynamics that shape low-income Hispanics' illness and treatment experiences and support the use of patient-centered approaches to reduce the morbidity and mortality associated with diabetes and depression.Mental health, Hispanic American studiesljc2139Social WorkArticlesPrevalence and Predictors of Mental Health Distress Post-Katrina: Findings From the Gulf Coast Child and Family Health Studyhttp://academiccommons.columbia.edu/catalog/ac:154471
Abramson, David M.; Stehling-Ariza, Tasha; Garfield, Richard M.; Redlener, Irwin E.http://hdl.handle.net/10022/AC:P:15266Mon, 12 Nov 2012 00:00:00 +0000Background: Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. Methods: A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. Results: More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Conclusions: Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae.Public health, Mental healthdma3, nas51, rmg3, ir2110Population and Family Health, Epidemiology, Pediatrics, National Center for Disaster Preparedness, Sociomedical SciencesArticlesCollaborative planning approach to inform the implementation of a healthcare manager intervention for hispanics with serious mental illness: a study protocolhttp://academiccommons.columbia.edu/catalog/ac:154477
Cabassa, Leopoldo J.; Druss, Benjamin; Wang, Yuanjia; Lewis-Fernandez, Robertohttp://hdl.handle.net/10022/AC:P:15247Mon, 12 Nov 2012 00:00:00 +0000Background: This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD). Methods: The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. Discussion: The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.Mental health, Hispanic American studiesljc2139, yw2016Social Work, Psychiatry, BiostatisticsArticles"It's Like Being in a Labyrinth": Hispanic Immigrants' Perceptions of Depression and Attitudes Toward Treatmentshttp://academiccommons.columbia.edu/catalog/ac:154480
Cabassa, Leopoldo J.; Lester, Rebecca; Zayas, Luis H.http://hdl.handle.net/10022/AC:P:15249Mon, 12 Nov 2012 00:00:00 +0000This study aimed to describe Hispanic immigrants' perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients' views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants' perceptions and attitudes into depression treatments.Mental health, Hispanic American studiesljc2139Social WorkArticlesMeasuring Latinos' Perceptions of Depression: A Confirmatory Factor Analysis of the Illness Perception Questionnairehttp://academiccommons.columbia.edu/catalog/ac:154149
Cabassa, Leopoldo J.; Lagomasino, Isabel T.; Dwight-Johnson, Megan; Hansen, Marissa C.; Xie, Binhttp://hdl.handle.net/10022/AC:P:15201Mon, 05 Nov 2012 00:00:00 +0000This study examined the psychometric properties of the Revised Illness Perception Questionnaire adapted for a clinical sample of low-income Latinos suffering from depression. Participants (N = 339) were recruited from public primary care centers. Their average age was 49.73 years and the majority was foreign born females of either Mexican or Central American descent. Confirmatory factor analysis was used to test the factor structure of this measure. Construct and discriminant validity and internal consistency were evaluated. After the elimination of three items because of low factor loadings (< .40) and the specification of seven error covariances, a revised model composed of 24 items had adequate goodness-of-fit indices and factor loadings, supporting construct validity. Each of the subscales reported satisfactory internal consistency. Intercorrelations between the 5 illness perception factors provided initial support for the discriminant validity of these factors in the context of depression. The establishment of the psychometric properties of this adapted measure will pave the way for future studies examining the role illness perceptions play in the help seeking and management of depression among Latinos.Mental health, Hispanic American studiesljc2139Social WorkArticlesRacial and Ethnic Differences in Diabetes Mellitus among People with and without Psychiatric Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditionshttp://academiccommons.columbia.edu/catalog/ac:154152
Cabassa, Leopoldo J.; Blanco, Carlos; Lopez-Castroman, Jorge; Lin, Keng-Han; Lui, Shang-Min; Lewis-Fernandez, Robertohttp://hdl.handle.net/10022/AC:P:15202Mon, 05 Nov 2012 00:00:00 +0000Objective: This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders. Method: Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N= 34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status. Results: Among people without psychiatric disorders, African Americans, Hispanics, and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for socio-demographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group. Conclusion: Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities.Mental healthljc2139, cb255Social Work, PsychiatryArticlesLatino Adults' Access to Mental Health Care: A Review of Epidemiological Studieshttp://academiccommons.columbia.edu/catalog/ac:154143
Cabassa, Leopoldo J.; Zayas, Luis H.; Hansen, Marissa C.http://hdl.handle.net/10022/AC:P:15199Mon, 05 Nov 2012 00:00:00 +0000Since the early 1980s, epidemiological studies using state-of-the-art methodologies have documented the unmet mental health needs of Latinos adults in the U.S. and Puerto Rico. This paper reviews 16 articles based on seven epidemiological studies, examines studies methodologies, and summarizes findings about how Latino adults access mental health services. Studies consistently report that, compared to non-Latino Whites, Latinos underutilize mental health services, are less likely to receive guideline congruent care, and rely more often on primary care for services. Structural, economic, psychiatric, and cultural factors influence Latinos' service access. In spite of the valuable information these studies provide, methodological limitations (e.g., reliance on cross-sectional designs, scarcity of mixed Latino group samples) constrict knowledge about Latinos access to mental health services. Areas for future research and development needed to improve Latinos' access and quality of mental health care are discussed.Mental health, Hispanic American studiesljc2139Social WorkArticlesIntegrating cross-cultural psychiatry into the study of mental health disparitieshttp://academiccommons.columbia.edu/catalog/ac:154146
Cabassa, Leopoldo J.http://hdl.handle.net/10022/AC:P:15200Mon, 05 Nov 2012 00:00:00 +0000Snowden’s article in the February issue of the Journal presents a comprehensive review of the literature regarding the role that practitioners’ bias plays in the development of racial and ethnic disparities in the current mental health system. Missing from this review is the growing literature that directly examines the role that culture plays in the expression, presentation, and course of mental illnesses.Mental healthljc2139Social WorkLettersMental Health Chartbook: Tracking the Well-being of People with Mental Health Challengeshttp://academiccommons.columbia.edu/catalog/ac:153223
http://hdl.handle.net/10022/AC:P:14883Thu, 11 Oct 2012 00:00:00 +0000This chartbook documents the prevalence of mental health problems and illness, patterns of treatment and service use, cost of mental health care and quality of care, and life measures for children, adults and the elderly in the United States from the mid-1990s to 2008. Trends are also examined across different racial/ethnic groups and income levels. The data are compiled from nine different national and local surveys.Mental healthNational Center for Children in PovertyReportsWhat Can CCDF Learn from the Research on Children's Health and Safety in Child Care?http://academiccommons.columbia.edu/catalog/ac:153226
Banghart, Patti L.; Kreader, J. Leehttp://hdl.handle.net/10022/AC:P:14884Thu, 11 Oct 2012 00:00:00 +0000A major goal of CCDF is to provide low-income children with access to high-quality care that supports their health and safety. Research underscores the role of health and safety in child care in supporting children's physical, cognitive, and social-emotional development, all of which contribute to their school readiness. Regulations vary widely across states, and more needs to be learned about how regulations, enforcement of regulations, and supports could best improve child outcomes.Mental healthplb2001, jk821National Center for Children in PovertyReportsThe Impact of Outness and Lesbian, Gay, and Bisexual Identity Formation on Mental Healthhttp://academiccommons.columbia.edu/catalog/ac:151767
Feldman, Sarah Evanshttp://hdl.handle.net/10022/AC:P:14421Fri, 17 Aug 2012 00:00:00 +0000Conflicting literature exists for the relationship between first disclosure, outness, sexual minority identity, and mental health among lesbian, gay, and bisexual (LGB) individuals. That is, while the relationship between LGB identity and mental health has been relatively consistently positive in the literature, the relationship between outness and mental health is more mixed. In addition, the way these constructs differ among race, sex, and sexual orientation are rarely examined. The present study examined the complex relationship between first disclosure, outness, identity, and mental health among 192 lesbian, gay, and bisexual individuals collected from an online sample. The study explored differences on these variables by biological sex, race, age, and sexual orientation. The major findings revealed that bisexual males have less developed sexual minority identities and view their identities less positively than do lesbian, gay, and bisexual female individuals. In addition, bisexual individuals overall are less out and come out later for the first time in comparison to lesbian and gay individuals. In terms of race, Caucasians have a stronger and more positive view of their sexual identity in comparison to individuals of color. It was also found that individuals in later stages of sexual identity development experienced a more positive view of their sexual identity. In terms of mental health, it was revealed that a stronger sexual identity was related to better mental health. Greater degree of outness was found to overall have a moderately positive impact on mental health, though age of first disclosure of sexual minority status was, overall, not associated to measures of identity or mental health. When examined more closely, outness had a more complex, dual impact on mental health. Specifically, outness was found to have both positive and negative consequences for mental health, with identity development accounting for the positive aspects of outness. Directions for future research and implications for clinicians are also discussed.GLBT studies, Mental healthsef2122Counseling and Clinical Psychology, Clinical PsychologyDissertationsCapturing Intervention Effects Over Time: Reanalysis of a Critical Time Intervention for Homeless Mentally Ill Menhttp://academiccommons.columbia.edu/catalog/ac:150540
Lennon, Mary Clare; McAllister, William; Kuang, Li; Herman, Daniel B.http://hdl.handle.net/10022/AC:P:14208Mon, 23 Jul 2012 00:00:00 +0000Objectives. We analyzed whether a method for identifying latent trajectories—latent class growth analysis (LCGA)—was useful for understanding outcomes for individuals subject to an intervention. Methods. We used LCGA to reanalyze data from a published study of mentally ill homeless men in a critical time intervention (CTI) program. In that study, 96 men leaving a shelter's onsite psychiatric program were randomly assigned to experimental and control groups. The former received CTI services and the latter usual services. Each individual's housing circumstances were observed for 18 months after program initiation. Our outcome measure was monthly homelessness: a person was considered homeless in a month if he was homeless for even 1 night that month. Results. Four latent classes were found among the control group, but just 3 among the experimental group. Control, but not experimental, group individuals showed a small class of chronically homeless men. The size of the never-homeless class was 19 percentage points larger for the experimental than for the control group. J- and inverted-U-shaped patterns were also found among both groups, but with important differences in timing of patterns. Conclusions. Our results reveal effects not apparent in the original analysis, suggesting that latent class growth models improve intervention evaluation.Mental healthmcl3, wm134, lk2019Sociomedical Sciences, Institute for Social and Economic Research and Policy, Social WorkArticlesPatterns and Outcomes of Bereavement Support-Seeking Among Older Adults with Complicated Grief and Bereavement-Related Depressionhttp://academiccommons.columbia.edu/catalog/ac:146829
Ghesquiere, Angela Rosabellehttp://hdl.handle.net/10022/AC:P:13201Wed, 09 May 2012 00:00:00 +0000The dissertation aims to enhance knowledge about bereavement support-seeking among older adults with Complicated Grief (CG) and/or depression and to examine the outcomes of support received. This three-paper dissertation uses data from two studies of bereaved older adults: the Changing Lives of Older Couples (CLOC) Study and the Complicated Grief Treatment in Older Adults (CGTOA) Study. The dissertation draws upon Pescosolido and colleagues' Network Episode Model to frame the exploration of support-seeking. Paper 1 is based on qualitative interviews with eight older adults with CG who completed participation in a National Institute of Mental Health (NIMH) funded randomized clinical trial of CG treatment, the CGTOA study, and seeks to better understand the bereavement support- seeking process. Several primary themes arose, including observing that grief was causing a great deal of emotional distress and role impairment, grief not meeting their own or others' expectations of what grief "should be," influences of social relationships on support-seeking, and a lack of effectiveness of support groups and/or care from mental health professionals. Papers 2 and 3 use secondary analyses of longitudinal surveys from the CLOC Study, a representative community sample of widowed older adults. Paper 2 describes support sought for grief at 6, 18, and 48 months post-widowhood, including religious leader, support group, and family doctor support, and examines the influence of social network variables, the presence of CG and depression, and other demographic (gender, education, age, race, income, and home ownership) and clinical variables (health satisfaction, anxiety severity, attachment anxiety, attachment avoidance) on support sought. Approximately 20% of the sample sought multiple types of support concurrently. Social network, clinical and demographic variables also varied across types of support sought. For example, the presence of CG was associated with a greater likelihood of seeking support, and low instrumental support increased the odds of going to family doctors for support with grief. There were also significant associations between types of support sought. Paper 3 determined whether utilization of bereavement supports at 6 months post-loss was associated with reductions in emotional distress (grief, depression, or anxiety) at 18 months in widows with CG or depression in the CLOC sample. Using a self-help or support group reduced grief symptoms, but did not significantly alter depression or anxiety symptoms. Seeking support from a religious leader decreased depression, but not grief or anxiety. Seeking support from a family doctor did not impact anxiety, depression or grief. Discussion sections for each paper and a conclusion section for the entire dissertation summarize study findings, identify limitations, and detail implications for practice, research, and policy.Mental health, Gerontologyag2813Social Work, PsychiatryDissertationsHow Unreliable are adult-reported suicide attempts? An examination of correlates and underlying causal mechanisms of discordant reporting over timehttp://academiccommons.columbia.edu/catalog/ac:174278
Palmetto, Niki P.http://hdl.handle.net/10022/AC:P:11762Wed, 09 Nov 2011 00:00:00 +0000The challenge of capturing suicide attempts in the population, plague its examination. The reliability of adult-reported lifetime suicide attempts had not been rigorously explored prior to this work, and therefore estimates have remained largely unchallenged. This dissertation explicitly sought to fill this research gap by utilizing a longitudinal study, comprising two waves of data collection, in which information on suicide attempts was obtained at both time points. Chapter 1 presents a systematic review of the literature depicting the state of the literature with regards to the reliability of suicidality measures (e.g. ideation, plans, and attempts). Few studies assessed correlates of discordant reporting, and no studies examined the reliability of adult-reported suicide attempts. Drawing upon the correlates reported within studies, as well sources of heterogeneity across studies, I posited four plausible causal mechanisms underlying discordant suicidality reporting; recall failure, reinterpretation, conscious denial, and lack of construct comprehension. Extending these findings, I proposed that the likelihood of each mechanism is influenced by factors such as the severity of the suicidality, amount of time passed since the suicidal event, social desirability effects, mood context, and suicide construct validity. In Chapter 2, I assessed the reliability of adult-reported lifetime attempts as reported in a large, population-based longitudinal study, and found reports to be moderately reliable, with a Kappa coefficient of 0.51. I hypothesized that discordant reporters would be more similar to individuals who reported a past attempt at both waves (Concordant yes responders), compared with individuals who reported no attempt at both waves (Concordant no responders). I found that indeed, discordant reporters were more similar to the former, potentially signifying that discordant reporters are true attempters who underreported their attempt at one time point. Further, I hypothesized that discordant reporters would be less likely to have a history of depressive disorders compared with Concordant yes responders; positing that this history would serve as a marker for attempt severity, and that discordants would have less severe attempts, which would therefore be more easily forgotten or reinterpreted. Contrary to this hypothesis however, discordants were as likely as Concordant yes individuals to have a history of depressive disorders, and unexpectedly, discordants were much less likely to have a history of suicidal ideation. It is therefore plausible that a history of suicidal ideation serves as a marker for attempt severity, and/or that discordant reporters are characterized by more impulsive attempts. In Chapter 3, I examined how a respondent's current depressed mood may influence the recall, and hence reporting of attempts. Based on established mood-recall theories, I tested three competing hypotheses to determine if a current depressed mood would enhance (mood-congruent recall), inhibit (mood memory deficit effect), or have no effect on the recall (mood-independent recall) and reporting of attempts. I hypothesized that discordant reporters would demonstrate a mood-congruent pattern of reporting, such that a depressed mood at the time of the interview would increase the likelihood that a respondent would report an attempt at that wave. There were in fact, distinct mood-congruent reporting effects among Recanters, yet mood-independent effects detected among New endorsers. This may indicate that New endorsers are a unique group of discordant responders, which warrant further examination. Still, because respondents in our sample were over 20 times more likely to recant than newly endorse, and comparatively, there was limited power within our New endorser group, I believe these results may be generalized to assert that overall, discordant responders report in a mood-congruent fashion.Epidemiology, Mental health, Public healthEpidemiology, Sociomedical SciencesDissertationsMentally Ill or Chosen by Spirits? Illness Concepts and the Revival of Spiritual Healing in Post-Soviet Kazakhstanhttp://academiccommons.columbia.edu/catalog/ac:139566
Penkala-Gawecka, Danutahttp://hdl.handle.net/10022/AC:P:11338Mon, 03 Oct 2011 00:00:00 +0000During many years of the Soviet regime and communist indoctrination in Central Asia indigenous healing practices were condemned and the healers, as well as mullahs, suffered persecution. Despite those efforts, traditional healing was not entirely eradicated and after the collapse of the Soviet Union it has been reappraised in the new independent Central Asian states. This paper, based on my fieldwork in Kazakhstan between 1995-2000, focuses on the concept of a specific illness, connected with spiritual calling, which was traditionally held by the local population and has acquired a new significance with the revival of spiritual healing. This illness was previously easily recognized as a manifestation of “shamanic calling”, visible proof that the sufferer had been chosen by spirits. When western biomedicine gained dominance and the communist policy reduced the strength of local traditions, similar symptoms got different meaning, assigned by biomedical specialists. Diagnosed as mentally ill, a person with such symptoms was usually sent to a psychiatric ward. The notion of illness caused by spirits has been restored in the 1990s, with the political, economic and social changes that led to the upsurge of spiritual healing. Although new, bureaucratic legitimization of the healers has been officially introduced, traditional legitimization remains crucial in the way of contemporary spiritual healers, with two main components: spiritual calling manifested through the illness, and shamanic/spiritual succession. I argue that particularities of the perception of this illness and its significance for the emergence of new healers can be understood only in the broader context of transformations following the independence of the former Soviet Republics.Mental health, Alternative medicine, Near Eastern studiesGlobal Health Research Center of Central AsiaPresentationsJuvenile Justice in the U.S.: Facts for Policymakershttp://academiccommons.columbia.edu/catalog/ac:135894
Gottesman, David M.; Schwarz, Susan Wilehttp://hdl.handle.net/10022/AC:P:10756Wed, 20 Jul 2011 00:00:00 +0000Recent research shows that the human brain continues to develop throughout adolescence, with the pre-frontal cortex – the section of the brain responsible for executive function and complex reasoning – not fully developing until the mid-twenties. Because adolescents' brains are not fully matured, their decision-making and thought processes differ from those of adults. For example, it is developmentally normative for adolescents to take greater risks and show greater susceptibility to peer influences than adults. These otherwise normal differences can contribute to behaviors that lead to involvement with the juvenile justice system. Beyond developmental influences, additional risk factors associated with youth ending up in the juvenile justice system are cognitive deficits, low school involvement, living in poverty, or being runaway or homeless. Just over two million youth under the age of 18 were arrested in 2008. Of these two million, about 95 percent had not been accused of violent crimes, such as murder, rape, or aggravated assault. In 2010, of the nearly 100,000 youth under the age of 18 who were serving time in a juvenile residential placement facility, 26 percent had been convicted of property crimes only, such as burglary, arson, or theft. For nonviolent youth involved in the juvenile justice system, incarceration in traditional residential placement facilities often does more harm than good. These large residential facilities are ineffective at providing the services and rehabilitation these youth need, and this lack of capacity contributes to high recidivism rates (rearrest within one year of release). Reliance on these residential placement facilities is an inefficient use of taxpayer money, not only with regard to the funds needed to keep youth in these facilities, but also the future lower wages and lost productivity that often follows for these youth. Reform efforts must place a greater focus on improving access to mental health services for all youth, better serving the needs of youth who are involved in the juvenile justice system, and creating effective alternatives to traditional residential placement facilities. Proper treatment and rehabilitative services can help many youth currently in the juvenile system become healthy and productive members of society.Criminology, Mental health, Developmental psychologydg2575, sws19National Center for Children in PovertyReportsImproving the Odds for Adolescents: State Policies that Support Adolescent Health and Well-beinghttp://academiccommons.columbia.edu/catalog/ac:135891
Schwarz, Susan Wile; Aratani, Yumikohttp://hdl.handle.net/10022/AC:P:10755Wed, 20 Jul 2011 00:00:00 +0000For policymakers, adolescence presents an invaluable opportunity to ensure that all young people can access the high-quality services and supports they need to improve their odds of becoming successful, healthy, productive adults. At an historic moment when the provisions and breadth of health care reform are under vigorous debate, it is important to take stock of how well the states are currently meeting the health and development needs of all adolescents, and particularly disadvantaged youth. This report presents information from NCCP's Improving the Odds for Adolescents project about state policy choices that affect the health and well-being of adolescents.Public health, Mental healthsws19, ya61National Center for Children in PovertyReportsBuilding Strong Systems of Support for Young Children's Mental Health: Key Strategies for States and a Planning Toolhttp://academiccommons.columbia.edu/catalog/ac:135883
Smith, Sheila; Stagman, Shannon M.; Blank, Susan; Ong, Christine; McDow, Kendrahttp://hdl.handle.net/10022/AC:P:10752Tue, 19 Jul 2011 00:00:00 +0000Young children's mental health provides an essential foundation for early learning and development. In the early years, children's mental health can be seen in a wide range of behaviors that promote engagement in social relationships and learning. An infant who joyfully participates in "conversation" with parents is acquiring a capacity for strong social relationships while learning language and the patterns of communication. A toddler shows positive mental health by actively investigating her environment while gaining new cognitive and motor skills during play and exploration. A preschooler who helps his friend build a robot, shares his favorite markers, and rebuilds his block tower after it tumbles is learning social and problem-solving skills that will fuel learning in preschool and beyond. In sum, young children's "mental health" refers to emotional wellbeing and positive social development from birth through age 5. Young children with mental health problems miss out on developmental experiences that promote early learning. The behavior problems of some children result in actual expulsion from early care and education settings. For other children, mental health problems and challenging behavior may limit positive engagement in learning by contributing to conflictual relationships with teachers and classmates. Young children experiencing sadness or anxiety may find it hard to fully participate in growth-promoting play and learning activities. At home, young children with problem behaviors may be caught in a cycle of negative interactions with parents that disrupt a nurturing parent-child relationship and further limit support for the child's healthy development. Recent estimates suggest that between nine and 14 percent of children under age experience emotional and behavioral problems. The prevalence of mental health problems is markedly higher for children in families facing economic hardship and other stressful circumstances, such as maternal depression. In the absence of interventions, mental health conditions that emerge in the early years tend to persist and interfere with healthy development and learning. State leaders increasingly recognize the critical link between young children's mental health and later social adjustment and success in school. In recent years, states have begun to develop new policies and programs that help establish supports for young children's mental health across a wide range of settings, including pediatric offices and community clinics, early childhood and home-visiting programs, and child welfare agencies. These efforts focus on promoting positive mental health, preventing potential mental health problems, and treating identified delays or difficulties in social-emotional development. Many states' efforts include the use of evidence-based models and training experiences for service providers to increase their knowledge and skills. Part I of this report describes key strategies that should be part of a comprehensive system of supports for young children's mental health and examples from states that are developing and implementing them. These strategies are: promoting early childhood mental health (ECMH) in home visiting and parenting programs; enhancing supports for ECMH in early care and education programs; screening parents for depression; screening children for social-emotional problems; developing a better-trained workforce to address the social-emotional needs of young children; using evidence-based practices and evaluation to promote effective ECMH programs; and supporting the well-being of exceptionally vulnerable children. Part II of this report presents a simple tool that state planners can use for two purposes: 1) to assess the current status of the state's ECMH supports; and 2) to plan for specific enhancements in the state's current system, including expansion of certain ECMH strategies, such as child screening or training for early childhood teachers, and improvements in the quality of interventions. Since the creation of strong systems of ECMH supports requires collaboration among multiple agencies and programs, this tool may be especially useful for Early Childhood Advisory Councils, Early Childhood Comprehensive Systems initiatives, and similar state-level planning entities that bring together leaders from different sectors.Individual and family studies, Mental healthss3793, ss3770National Center for Children in PovertyReportsReward system in children and adolescents with ADHD and anxiety disordershttp://academiccommons.columbia.edu/catalog/ac:130524
Mazzone, Luigihttp://hdl.handle.net/10022/AC:P:10079Wed, 30 Mar 2011 00:00:00 +0000Behavioral sciences, Clinical psychology, Mental healthItalian AcademyWorking papersPsychometric attributes of the DISC Predictive Scaleshttp://academiccommons.columbia.edu/catalog/ac:129506
Cubo, Esther; Velasco, Sara Saez; Benito, Vanesa Delgado; Villaverde, Vanesa Ausin; Gabriel and Galan, Jose Maria Trejo; Santidrian, Asuncion Martin; Vicente, Jesus Macarron; Guevara, Jose Cordero; Louis, Elan D.; Leon, Julian Benitohttp://hdl.handle.net/10022/AC:P:9797Thu, 13 Jan 2011 00:00:00 +0000Introduction: This study was designed to evaluate the psychometric attributes and screening efficiency of a Spanish version of the Children Predictive Scales (DPS) against the Spanish Diagnostic Interview Schedule for Children (DISC-IV). Method: This pilot cross-sectional study included 61 children aged 9 to 14 years in a mainstream school. The following psychometric attributes were analyzed: acceptability, scale assumptions, internal consistency, and precision, as well the predictive validity (AUC). Results: The scale did not show ceiling or floor effects (6.4%, 1.3%, respectively). The internal consistency was high (α±=0.92), and the standard error of measurement was adequate (SEM=1.54). The overall DPS AUC was 0.72 against DISC IV corresponding diagnosis. Conclusion: The Spanish version of the DPS-4.32 seems to be a reliable and precise tool for screening mental health disorders in a school-age population.Mental health, Neurosciencesedl2Epidemiology, Center for Parkinson's Disease and Other Movement DisordersArticles